Provider Demographics
NPI:1922356989
Name:BROWN, SUSAN AMANDA (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMANDA
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 SUN N LAKE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2171
Mailing Address - Country:US
Mailing Address - Phone:863-382-2248
Mailing Address - Fax:863-382-1242
Practice Address - Street 1:4325 SUN N LAKE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2171
Practice Address - Country:US
Practice Address - Phone:863-382-2248
Practice Address - Fax:863-382-1242
Is Sole Proprietor?:No
Enumeration Date:2012-08-24
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17991363LA2200X
FLAPRN11010315363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01124930OtherRAILROAD MEDICARE
SCNP2113Medicaid
SCAA98095213Medicare PIN
SCP01124930OtherRAILROAD MEDICARE
SCAA98095019Medicare PIN
SCAA98093365Medicare PIN