Basic Information
| Provider Information | |||||||||
| NPI: | 1508100512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIS | ||||||||
| FirstName: | SUZAN | ||||||||
| MiddleName: | MARGERY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 E ALTAMONTE DR | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077670009 | ||||||||
| FaxNumber: | 4077670022 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 E ALTAMONTE DR | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077670009 | ||||||||
| FaxNumber: | 4077670022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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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 | 363LA2200X | 646612 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.