Provider Demographics
NPI:1811423536
Name:DARVILLE, SUZANNE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DARVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 MENENDEZ ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-6126
Mailing Address - Country:US
Mailing Address - Phone:772-882-0233
Mailing Address - Fax:772-672-4650
Practice Address - Street 1:3403 MENENDEZ ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-6126
Practice Address - Country:US
Practice Address - Phone:772-882-0233
Practice Address - Fax:772-672-4650
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93636OtherCNA
FL002465500Medicaid
FL236936Medicaid