Provider Demographics
NPI:1639474232
Name:CORLEY, SUSAN K (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:CORLEY
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 1:5412 GROVE VALLEY RD
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-7917
Mailing Address - Country:US
Mailing Address - Phone:850-562-8015
Mailing Address - Fax:
Practice Address - Street 1:1801 MICCOSUKEE COMMONS DR
Practice Address - Street 2:OPTIONAL
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5433
Practice Address - Country:US
Practice Address - Phone:850-562-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9238985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily