Provider Demographics
NPI:1992178842
Name:CARTER-NEALY, SUSEN ANNETTE (NP)
Entity Type:Individual
Prefix:
First Name:SUSEN
Middle Name:ANNETTE
Last Name:CARTER-NEALY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSEN
Other - Middle Name:ANNETTE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:200 CONGRESS PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4688
Practice Address - Country:US
Practice Address - Phone:561-279-0991
Practice Address - Fax:561-279-0539
Is Sole Proprietor?:No
Enumeration Date:2015-11-01
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily