Provider Demographics
NPI:1861428682
Name:OCONNOR, SUSAN ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1250 S 18TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1902
Mailing Address - Country:US
Mailing Address - Phone:904-277-4690
Mailing Address - Fax:904-277-8487
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-277-4690
Practice Address - Fax:904-277-8487
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP745872363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health