Basic Information
| Provider Information | |||||||||
| NPI: | 1811153281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINGWOOD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 RINGLING BLVD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342376102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418612900 | ||||||||
| FaxNumber: | 9418612719 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 RINGLING BLVD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342376102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418612900 | ||||||||
| FaxNumber: | 9418612719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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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 | 14-71386011 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 019211600 | 05 | FL | MEDICAID | ARNP9398501 | 01 | FL | LICENSE | OTHER |