Provider Demographics
NPI:1417276510
Name:RING, SUZI WILLIS (R,MR)
Entity Type:Individual
Prefix:
First Name:SUZI
Middle Name:WILLIS
Last Name:RING
Suffix:
Gender:F
Credentials:R,MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30970 PARADISE COMMONS
Mailing Address - Street 2:#322
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8056
Mailing Address - Country:US
Mailing Address - Phone:904-206-4499
Mailing Address - Fax:
Practice Address - Street 1:1699 S 14TH ST
Practice Address - Street 2:STE 16
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1963
Practice Address - Country:US
Practice Address - Phone:904-491-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT639122471C3402X
FL3837502471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography