Provider Demographics
NPI:1639228810
Name:GARRETT, SUSAN M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:GARRETT
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 1:3325 BOUGAINVILLEA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5704
Mailing Address - Country:US
Mailing Address - Phone:941-915-0632
Mailing Address - Fax:941-929-0904
Practice Address - Street 1:3325 BOUGAINVILLEA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5704
Practice Address - Country:US
Practice Address - Phone:941-915-0632
Practice Address - Fax:941-929-0904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1318812163WR0006X
FLARNP1318812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311759600Medicaid
FLY041DOtherBLUE CROSS AND BLUE SHIEL
FLY041DOtherBLUE CROSS AND BLUE SHIEL
FL311759600Medicaid