Provider Demographics
NPI:1518976802
Name:CONRAD, SUZANNE S (ARNP)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:S
Last Name:CONRAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUZANNA
Other - Middle Name:SHUNK
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0751
Mailing Address - Fax:352-265-0755
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0751
Practice Address - Fax:352-265-0755
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3386612363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305976600Medicaid
FLU5126ZMedicare PIN