Provider Demographics
NPI:1225391758
Name:SYME, SUE ELLYN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLYN
Last Name:SYME
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 TAMPA BLVD
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2982
Mailing Address - Country:US
Mailing Address - Phone:850-240-9485
Mailing Address - Fax:
Practice Address - Street 1:2042 TAMPA BLVD
Practice Address - Street 2:N/A
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2982
Practice Address - Country:US
Practice Address - Phone:850-240-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9181083163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse