Provider Demographics
NPI:1134368293
Name:WELCH, SUZANNE LYNNE (CST/CFA)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LYNNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380535
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0535
Mailing Address - Country:US
Mailing Address - Phone:941-743-5741
Mailing Address - Fax:
Practice Address - Street 1:21254 PEACHLAND BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3849
Practice Address - Country:US
Practice Address - Phone:941-743-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113007246ZC0007X
FL93638246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist