Provider Demographics
NPI:1578846481
Name:BATEMAN, SUSAN L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:BATEMAN
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 1:1 TAMPA GENERAL CIR # G417
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-7968
Mailing Address - Fax:813-844-4049
Practice Address - Street 1:1 TAMPA GENERAL CIR # G417
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-7968
Practice Address - Fax:813-844-4049
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9208608363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y09KBOtherBLUE CROSS BLUE SHIELD
FL004390000Medicaid
Y09KBOtherBLUE CROSS BLUE SHIELD