Provider Demographics
NPI:1518114867
Name:BRAY, SUSAN LEIGH (DNP, FNP-C, APRN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEIGH
Last Name:BRAY
Suffix:
Gender:F
Credentials:DNP, FNP-C, APRN
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:LEIGH
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-C, APRN
Mailing Address - Street 1:755 27TH AVE SW STE 9
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-4210
Mailing Address - Country:US
Mailing Address - Phone:772-214-4369
Mailing Address - Fax:772-492-6624
Practice Address - Street 1:755 27TH AVE SW STE 9
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4210
Practice Address - Country:US
Practice Address - Phone:772-492-6607
Practice Address - Fax:772-492-6624
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021307363LF0000X
IN71002694A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939750Medicaid
INP01058802OtherRR MEDICARE PTAN
IN265900AMedicare PIN
INM400039191Medicare PIN
INM400039205Medicare PIN
INM400039197Medicare PIN
INM400039209Medicare PIN
INP01058802OtherRR MEDICARE PTAN
INM400054561Medicare PIN
INM400039188Medicare PIN