Provider Demographics
NPI:1831582378
Name:NEIL, SUSAN (PMHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:NEIL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 DIXIE HWY NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3682
Mailing Address - Country:US
Mailing Address - Phone:321-622-3222
Mailing Address - Fax:321-622-3203
Practice Address - Street 1:4031 DIXIE HWY NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3682
Practice Address - Country:US
Practice Address - Phone:321-622-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1686782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty