Provider Demographics
NPI:1114438124
Name:BLIZZARD, SUSAN MICHELLE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELLE
Last Name:BLIZZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W TUDOR RD
Mailing Address - Street 2:STE 5
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-235-7000
Mailing Address - Fax:907-235-4050
Practice Address - Street 1:211 RANCHERA ST NW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4866
Practice Address - Country:US
Practice Address - Phone:386-364-1751
Practice Address - Fax:386-364-1761
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9217611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily