Provider Demographics
NPI:1356323075
Name:YEOMANS, SUSAN R (ARNP, CNM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:YEOMANS
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 NEW BRITTANY BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4690
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:1265 VISCAYA PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3237
Practice Address - Country:US
Practice Address - Phone:239-574-2229
Practice Address - Fax:239-574-2762
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN567322367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000011209MOtherHUMANA
FL302146700Medicaid
FLY6072WMedicare PIN
FLS57800Medicare UPIN
FL302146700Medicaid