Provider Demographics
NPI:1265699854
Name:A SUSAN NELSON, ARNP, INC.
Entity type:Organization
Organization Name:A SUSAN NELSON, ARNP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:A SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ARNP
Authorized Official - Phone:772-692-3140
Mailing Address - Street 1:3098 SE BUR ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5855
Mailing Address - Country:US
Mailing Address - Phone:772-692-3140
Mailing Address - Fax:772-692-3144
Practice Address - Street 1:1711 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9631
Practice Address - Country:US
Practice Address - Phone:772-692-3140
Practice Address - Fax:772-692-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3039062364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302409100Medicaid
FL1750399812Medicare NSC
FL302409100Medicaid