Provider Demographics
NPI:1831449339
Name:JAFFE, SUZAN (ARNP, PHD)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:ARNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COMPASS LN
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2009
Mailing Address - Country:US
Mailing Address - Phone:305-606-5462
Mailing Address - Fax:
Practice Address - Street 1:61 COMPASS LN
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2009
Practice Address - Country:US
Practice Address - Phone:305-606-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1452222163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health