Provider Demographics
NPI:1376619882
Name:MILLER, SUSAN K (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:MILLER
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 1:5175 W WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34433-2660
Mailing Address - Country:US
Mailing Address - Phone:352-465-0141
Mailing Address - Fax:
Practice Address - Street 1:5175 W WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34433-2660
Practice Address - Country:US
Practice Address - Phone:352-465-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2140782174400000X
FLARNP21407822367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN146227OtherHTHEZ
FLG1271OtherBCBS
FL300884300Medicaid
FLARNP2140782OtherW C
FL592689712OtherUHC
FLG1271OtherBCBS
FL300884300Medicaid