Provider Demographics
NPI:1083199962
Name:LOGAN, SUSAN NEWELL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NEWELL
Last Name:LOGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:OLGA DAWN
Other - Middle Name:SUSAN NEWELL
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:411 HOUNDS RUN E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5404
Mailing Address - Country:US
Mailing Address - Phone:251-490-7817
Mailing Address - Fax:
Practice Address - Street 1:1800 SAINT MARY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1096
Practice Address - Country:US
Practice Address - Phone:850-595-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9370450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily