Provider Demographics
NPI:1275994071
Name:BORGIASZ, SUSAN IRENE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:IRENE
Last Name:BORGIASZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:IRENE
Other - Last Name:BANASZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:
Practice Address - Street 1:2424 MANATEE AVE W STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4954
Practice Address - Country:US
Practice Address - Phone:941-847-7920
Practice Address - Fax:941-757-2291
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173210363LF0000X
FLAPRN9474864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily