Provider Demographics
NPI:1205138948
Name:HILDEBRANDT, SUSAN EILEEN (NP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EILEEN
Last Name:HILDEBRANDT
Suffix:
Gender:F
Credentials:NP
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-495-4490
Mailing Address - Fax:239-495-4491
Practice Address - Street 1:26800 S TAMIAMI TRL STE 340
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4355
Practice Address - Country:US
Practice Address - Phone:239-495-4490
Practice Address - Fax:239-495-4491
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1026A363L00000X
FLAPRN11003353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104641500Medicaid