Provider Demographics
NPI:1710126719
Name:THOMAS, SUZAN E (CRNA)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 CONGRESS AVE STE 3212
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1358
Mailing Address - Country:US
Mailing Address - Phone:954-426-4240
Mailing Address - Fax:561-717-9342
Practice Address - Street 1:10101 FOREST HILL BLVD.
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-798-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9235406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000814800Medicaid
FLG4748OtherBCBS
FLG4748OtherBCBS