Provider Demographics
NPI:1598894362
Name:THUL, SUSAN M (ARNP, CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:THUL
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4189
Mailing Address - Country:US
Mailing Address - Phone:772-462-3800
Mailing Address - Fax:
Practice Address - Street 1:714 AVENUE C
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4189
Practice Address - Country:US
Practice Address - Phone:772-462-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL352555367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ01758Medicare UPIN