Provider Demographics
NPI:1093957920
Name:LEE, SUSAN P (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:LEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:P
Other - Last Name:ALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:109 BURNEY RD
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9441
Mailing Address - Country:US
Mailing Address - Phone:941-685-8367
Mailing Address - Fax:
Practice Address - Street 1:8546 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238
Practice Address - Country:US
Practice Address - Phone:941-918-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6918-33363L00000X
FLARNP1718972363LF0000X
FL1718972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001610100Medicaid
FLY01C6OtherBCBS FLORIDA
FLY01C6OtherBCBS FLORIDA