Provider Demographics
NPI:1811940448
Name:STUIB, SUSAN (ARNP,FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:STUIB
Suffix:
Gender:F
Credentials:ARNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 BRIDGEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6186
Mailing Address - Country:US
Mailing Address - Phone:407-243-2663
Mailing Address - Fax:
Practice Address - Street 1:3861 AVALON PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4853
Practice Address - Country:US
Practice Address - Phone:407-378-5300
Practice Address - Fax:407-378-5306
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3359392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000467200Medicaid