Provider Demographics
NPI:1851344113
Name:OLIVER, SUZANNE M (CRNA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:OLIVER
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:P.O. BOX 550412
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-0000
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:
Practice Address - Street 1:4470 SHERIDAN STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-0000
Practice Address - Country:US
Practice Address - Phone:954-962-3210
Practice Address - Fax:954-577-8556
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1835842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034107000Medicaid
FLG0887OtherBLUE SHIELD PROV #
FLG0887XMedicare PIN