Provider Demographics
NPI:1255315438
Name:DAFFIN, SUSAN LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:DAFFIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919030
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9030
Mailing Address - Country:US
Mailing Address - Phone:850-431-1155
Mailing Address - Fax:850-656-4276
Practice Address - Street 1:2010 FLEISCHMANN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4599
Practice Address - Country:US
Practice Address - Phone:850-431-1155
Practice Address - Fax:850-656-4276
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP731082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034720500Medicaid
FLG0595ZMedicare ID - Type Unspecified