Provider Demographics
NPI:1073057550
Name:GAUTHIER, SUZELLE
Entity Type:Individual
Prefix:MS
First Name:SUZELLE
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUZELLE
Other - Middle Name:
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:8483 BLUE CYPRESS DR
Mailing Address - Street 2:8483 BLUE CYPRESS DR
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6244
Mailing Address - Country:US
Mailing Address - Phone:561-856-8441
Mailing Address - Fax:
Practice Address - Street 1:8483 BLUE CYPRESS DR
Practice Address - Street 2:8483 BLUE CYPRESS DR
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6244
Practice Address - Country:US
Practice Address - Phone:561-856-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9329072363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care