Provider Demographics
NPI:1497737910
Name:IRVIN, SUSAN URELL (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:URELL
Last Name:IRVIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551616 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:FL
Mailing Address - Zip Code:32046-8281
Mailing Address - Country:US
Mailing Address - Phone:904-845-3574
Mailing Address - Fax:904-845-7418
Practice Address - Street 1:551616 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:FL
Practice Address - Zip Code:32046-8281
Practice Address - Country:US
Practice Address - Phone:904-845-3574
Practice Address - Fax:904-845-7418
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1440112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033120100Medicaid
FL033120100Medicaid