Provider Demographics
NPI:1861853871
Name:DAMIEN, SUSAN MIRANDA (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MIRANDA
Last Name:DAMIEN
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 NE 36TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-1335
Mailing Address - Country:US
Mailing Address - Phone:352-833-6372
Mailing Address - Fax:
Practice Address - Street 1:317 NE 36TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-1335
Practice Address - Country:US
Practice Address - Phone:352-833-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-152310163W00000X
FL9246912363LA2100X, 163W00000X, 363LF0000X
FLARNP9246912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018831700Medicaid
FL018831700Medicaid