Provider Demographics
NPI:1033426788
Name:SUDDUTH, AMELIA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:L
Last Name:SUDDUTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 SUGAR MILL BND
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8646
Mailing Address - Country:US
Mailing Address - Phone:850-995-7059
Mailing Address - Fax:
Practice Address - Street 1:4333 SUGAR MILL BND
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8646
Practice Address - Country:US
Practice Address - Phone:850-995-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9267012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse