Provider Demographics
NPI:1700909389
Name:EMMERICH, SUSAN L (ARNP, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:EMMERICH
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6330
Mailing Address - Country:US
Mailing Address - Phone:904-757-1998
Mailing Address - Fax:904-696-7462
Practice Address - Street 1:1215 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6330
Practice Address - Country:US
Practice Address - Phone:904-757-1998
Practice Address - Fax:904-696-7462
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC056595363LP0200X
FLARNP9380555363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAC 056595OtherIA NURSE LISCENSE
IA5200629OtherSTATE PHARMACY LISCENSE
FLARNP9380555OtherFL STATE LICENSE
FLARNP9380555OtherFL STATE LICENSE