MEDICARE: SUSAN ECKART GROSS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP3200462	FL

General Provider Information

NPI Number	:	1932116266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ECKART GROSS ARNP

Provider Business Mailing Address
First Line	:	3901 COCONUT PALM DR STE 120
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-8362
Country	:	US
Telephone Number	:	813-289-6597
Fax Number	:	813-289-6592

Provider Business Practice Location Address
First Line	:	3030 NORTH ROCKY POINT DRIVE WEST
Second Line	:	SUITE 670
City	:	TAMPA
State	:	FL
Zip	:	33607-5906
Country	:	US
Telephone Number	:	813-289-6597
Fax Number	:	813-289-6592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	02/28/2018

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