1932116266 NPI number — SUSAN ECKART GROSS ARNP

Table of content: SUSAN ECKART GROSS ARNP (NPI 1932116266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932116266 NPI number — SUSAN ECKART GROSS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSS
Provider First Name:
SUSAN
Provider Middle Name:
ECKART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENSEN
Provider Other First Name:
SUSAN
Provider Other Middle Name:
ECKART
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932116266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 COCONUT PALM DR STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33619-8362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-289-6597
Provider Business Mailing Address Fax Number:
813-289-6592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 NORTH ROCKY POINT DRIVE WEST
Provider Second Line Business Practice Location Address:
SUITE 670
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-289-6597
Provider Business Practice Location Address Fax Number:
813-289-6592
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP3200462 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)