Provider Demographics
NPI:1023446341
Name:CHASE, SUSAN (EDD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 RESEARCH PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3298
Mailing Address - Country:US
Mailing Address - Phone:407-823-6274
Mailing Address - Fax:407-823-5508
Practice Address - Street 1:12201 RESEARCH PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3298
Practice Address - Country:US
Practice Address - Phone:407-823-6274
Practice Address - Fax:407-823-5508
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL704662163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator