Provider Demographics
NPI:1407815632
Name:STEWART, SUSANNA KAY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:KAY
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:SUSANNA
Other - Middle Name:KAY
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ANESTHESIA DEPT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-393-5582
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002176367500000X
FLARNP9214586367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2694441-00Medicaid
GA685507863AMedicaid