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NPI Code Detail

MEDICARE: SUSAN KOVAC SANDERS CRNA

MEDICARE: SUSAN KOVAC SANDERS CRNA
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
1367500000XCertified Registered Nurse AnesthetistARNP9168731FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G2875OTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932147212
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN KOVAC SANDERS CRNA
Provider Business Mailing Address
First Line : 6110 SONG BREEZE TRCE
Second Line :
City : JOHNS CREEK
State : GA
Zip : 30097-1470
Country : US
Telephone Number : 404-754-6020
Fax Number : 770-379-4501
Provider Business Practice Location Address
First Line : 3602 KYOTO GARDENS DR
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33410-2713
Country : US
Telephone Number : 561-799-3388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 11/09/2011

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