Provider Demographics
NPI:1336127356
Name:MARTIN, SUSAN GRIFFIN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GRIFFIN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:14631 BRADDOCK OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4948
Mailing Address - Country:US
Mailing Address - Phone:321-402-1147
Mailing Address - Fax:
Practice Address - Street 1:13454 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6601
Practice Address - Country:US
Practice Address - Phone:321-402-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2974082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304878100Medicaid
FLP55300Medicare UPIN
FL304878100Medicaid
FLP55300Medicare UPIN