Provider Demographics
NPI:1437203486
Name:SKOUFATOS, SUSAN MARGARET (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARGARET
Last Name:SKOUFATOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MARGARET
Other - Last Name:PECARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10927 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-2524
Mailing Address - Country:US
Mailing Address - Phone:727-863-0991
Mailing Address - Fax:727-841-8145
Practice Address - Street 1:5623 US HIGHWAY 19
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3700
Practice Address - Country:US
Practice Address - Phone:727-841-9050
Practice Address - Fax:727-841-8145
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2805262163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health