Provider Demographics
NPI:1023036142
Name:BOYETT, SUSAN DARLENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DARLENE
Last Name:BOYETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9109
Mailing Address - Country:US
Mailing Address - Phone:229-534-0416
Mailing Address - Fax:
Practice Address - Street 1:2402 OSLER CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0205
Practice Address - Country:US
Practice Address - Phone:229-438-3300
Practice Address - Fax:229-438-4651
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN151248NPOtherLICENSE NUMBER