Provider Demographics
NPI:1932768348
Name:DAVIS, SUSAN RAE (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S OCEAN DR SUITE 209
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2915
Mailing Address - Country:US
Mailing Address - Phone:305-466-9988
Mailing Address - Fax:305-466-9989
Practice Address - Street 1:3800 S OCEAN DR SUITE 209
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-6614
Practice Address - Country:US
Practice Address - Phone:305-466-9988
Practice Address - Fax:305-466-9989
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily