Provider Demographics
NPI:1760456719
Name:MODI, SUSAN SNYDER (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SNYDER
Last Name:MODI
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 1:1309 CORNER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2354
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-978-5852
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:PM&RS 117
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-978-5852
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1102622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily