Provider Demographics
NPI:1639479264
Name:NOLAN, SUSAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7094
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:681 GOODLETTE RD N
Practice Address - Street 2:SUITE 130
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5458
Practice Address - Country:US
Practice Address - Phone:239-643-9767
Practice Address - Fax:239-649-5878
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2671363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2112XMedicare PIN
FLS73614Medicare UPIN