Basic Information
| Provider Information | |||||||||
| NPI: | 1104165141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKNER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ROBERTA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17347 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333187347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548683194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 N UNIVERSITY DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330716089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542277760 | ||||||||
| FaxNumber: | 9542279975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2013 | ||||||||
| LastUpdateDate: | 02/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP1985432 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.