1962461970 NPI number — SUSAN C JANNOU

Table of content: SUSAN C JANNOU (NPI 1962461970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962461970 NPI number — SUSAN C JANNOU

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962461970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2420 TAMIAMI TRL N
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NOKOMIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34275-3475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-966-1777
Provider Business Mailing Address Fax Number:
941-966-8628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2420 TAMIAMI TRL N
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NOKOMIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34275-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-966-1777
Provider Business Practice Location Address Fax Number:
941-966-8628
Provider Enumeration Date:
03/20/2006

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: 213E00000X , with the licence number:  PO 2384 , 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)

  • Identifier: 6201051 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82277789 . This is a "AARP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 480028734 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65353 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650951406 . This is a "CHAMPUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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