Basic Information
| Provider Information | |||||||||
| NPI: | 1477748721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAESER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11881-A E. COLONIAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328264723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073228645 | ||||||||
| FaxNumber: | 4072732181 | ||||||||
| Practice Location | |||||||||
| Address1: | 11881-A E. COLONIAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328264723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073670064 | ||||||||
| FaxNumber: | 4073228725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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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 | 363LF0000X | ARNP0941702 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 01204425 | 01 | FL | AMERIGROUP | OTHER | 308902900 | 05 | FL | MEDICAID | 439532 | 01 | FL | WELLCARE | OTHER |