Provider Demographics
NPI:1255388211
Name:SILVER, SUSAN B (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:SILVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12130 COUNTY ROAD 97
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-6105
Mailing Address - Country:US
Mailing Address - Phone:850-380-8812
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-380-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1425232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59139941OtherBLUE CROSS BLUE SHIELD
FLG2011OtherBLUE CROSS BLUE SHIELD
FLG2011OtherBLUE CROSS BLUE SHIELD