Provider Demographics
NPI:1982285870
Name:SIUT, SUSAN (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SIUT
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 SW 137TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1430
Mailing Address - Country:US
Mailing Address - Phone:305-777-3505
Mailing Address - Fax:
Practice Address - Street 1:9020 SW 137TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1430
Practice Address - Country:US
Practice Address - Phone:786-556-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013007363LF0000X
FLRN9231761163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency