Provider Demographics
NPI:1275739880
Name:CONRAD, SUSAN K (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:CONRAD
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:1615 PASADENA AVE S
Mailing Address - Street 2:SUITE #300
Mailing Address - City:S PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4516
Mailing Address - Country:US
Mailing Address - Phone:727-490-3030
Mailing Address - Fax:727-384-6167
Practice Address - Street 1:1516 PASADENA AVE S.
Practice Address - Street 2:#300
Practice Address - City:S. PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-1223
Practice Address - Country:US
Practice Address - Phone:727-490-3030
Practice Address - Fax:727-384-6167
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP739662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 739662OtherLICENSE