Provider Demographics
NPI:1285629998
Name:REITER, SUZANNE LESTA (MSN, WHNP-BC, FAANP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LESTA
Last Name:REITER
Suffix:
Gender:F
Credentials:MSN, WHNP-BC, FAANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 GULF BLVD
Mailing Address - Street 2:#806
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767
Mailing Address - Country:US
Mailing Address - Phone:616-745-8463
Mailing Address - Fax:
Practice Address - Street 1:8751 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3832
Practice Address - Country:US
Practice Address - Phone:727-524-4410
Practice Address - Fax:727-524-4410
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704094692163W00000X, 363LW0102X
FL2972182363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011712700Medicaid
MIN32840001Medicare PIN