Provider Demographics
NPI:1619082237
Name:HAMMERLING-HODGERS, SUSAN (PA-C, MPAS, DFAAPA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HAMMERLING-HODGERS
Suffix:
Gender:F
Credentials:PA-C, MPAS, DFAAPA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HAMMERLING-HODGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1286 FLORIDA AVE S STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2400
Mailing Address - Country:US
Mailing Address - Phone:321-301-4747
Mailing Address - Fax:321-633-3043
Practice Address - Street 1:1286 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2484
Practice Address - Country:US
Practice Address - Phone:321-301-4747
Practice Address - Fax:321-633-3043
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6060ZMedicare PIN
P38265Medicare UPIN