Provider Demographics
NPI:1093149569
Name:KORUM, SUZANNE (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:KORUM
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MCNEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 FLAGLER PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8313
Mailing Address - Country:US
Mailing Address - Phone:813-267-2040
Mailing Address - Fax:
Practice Address - Street 1:5150 BELFORT RD BLDG 400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6026
Practice Address - Country:US
Practice Address - Phone:904-580-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1853762363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health