Provider Demographics
NPI:1346355153
Name:HEATH, SUE ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:HEATH
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 861348
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-1348
Mailing Address - Country:US
Mailing Address - Phone:813-615-7914
Mailing Address - Fax:813-615-8134
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-615-7914
Practice Address - Fax:813-615-8134
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP997022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034201700Medicaid
FLP00605328OtherRR MEDICARE
FLG0093OtherBCBS
FLP00605328OtherRR MEDICARE
FL034201700Medicaid