Provider Demographics
NPI:1922545136
Name:HALL, SUSANNAH MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:MARIE
Last Name:HALL
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 1:110 CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3654
Mailing Address - Country:US
Mailing Address - Phone:813-344-7418
Mailing Address - Fax:
Practice Address - Street 1:110 CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3654
Practice Address - Country:US
Practice Address - Phone:813-344-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9342159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner