Provider Demographics
NPI:1538142377
Name:SCHAFFER, SUSAN D (PHD, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:PHD, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100187
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0187
Mailing Address - Country:US
Mailing Address - Phone:352-273-6366
Mailing Address - Fax:352-273-6568
Practice Address - Street 1:16939 SW 134TH AVE
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-5413
Practice Address - Country:US
Practice Address - Phone:352-495-2550
Practice Address - Fax:352-495-3401
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9168271363LF0000X
FLARNP9168271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP70765Medicare UPIN
FLE8197ZMedicare ID - Type Unspecified
FLE8197ZMedicare ID - Type Unspecified