Provider Demographics
NPI:1689939282
Name:MASON, SUSAN C (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-541-4420
Mailing Address - Fax:239-541-7501
Practice Address - Street 1:12801 WESTLINKS DR STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8001
Practice Address - Country:US
Practice Address - Phone:239-561-5050
Practice Address - Fax:239-343-4241
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9478030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101122000Medicaid
OH0070422Medicaid