Provider Demographics
NPI:1174638159
Name:WELCH, SUSAN R (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:WELCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:NEMOURS CHILDREN&APOS S CLINIC
Mailing Address - Street 2:PO BOX 409992
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-858-3988
Practice Address - Fax:904-858-3140
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1620982363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302267600Medicaid
GA183354418AMedicaid
Q74472Medicare UPIN
FL302267600Medicaid