Provider Demographics
NPI:1053382267
Name:ROBINSON, SUSAN ANNE (C-FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W MEETING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2246
Mailing Address - Country:US
Mailing Address - Phone:803-285-7414
Mailing Address - Fax:803-283-4329
Practice Address - Street 1:8351 CHARLOTTE HWY STE 200
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6553
Practice Address - Country:US
Practice Address - Phone:803-285-7414
Practice Address - Fax:803-283-4329
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-05484363LF0000X
VA17139457363LF0000X
SC23913363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021475C59OtherVA PTAN NUMBER
VA61459601OtherBLACK LUNG/FECA
OH000000342755OtherANTHEM
SC23913OtherLICENCE
OH2367657Medicaid
500027170OtherRAILROAD MEDICARE
500027170OtherRAILROAD MEDICARE
OH000000342755OtherANTHEM