Provider Demographics
NPI:1932342615
Name:ROWE, SUSAN LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:ROWE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LEE
Other - Last Name:BOUSUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:182 SE 936TH ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-7350
Mailing Address - Country:US
Mailing Address - Phone:352-231-9218
Mailing Address - Fax:
Practice Address - Street 1:182 SE 936TH ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:FL
Practice Address - Zip Code:32680-7350
Practice Address - Country:US
Practice Address - Phone:352-231-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9276630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008798700Medicaid
FLHG802ZMedicare UPIN