Provider Demographics
NPI:1497153316
Name:SCHICKLEY, SUSAN (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCHICKLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-0115
Practice Address - Street 1:11479 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7367
Practice Address - Country:US
Practice Address - Phone:352-597-3511
Practice Address - Fax:352-592-1155
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3055442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014081200Medicaid
FLIA533YMedicare PIN
FLIA533ZMedicare PIN
FLIA533XMedicare PIN