Susan Harcke, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9113754 Issued in FL

Practice address

964 Ajax Street Branch Health Clinic - Primary Care
Jacksonville, FL 32214-3752

Phone

(302) 353-8471

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Services, PC

  • Emergency Medicine Physician
  • Scranton, PA
  • NPI 1588686166
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1013080464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6547 KINGS RD",
            "city": "KEYSTONE HEIGHTS",
            "state": "FL",
            "postal_code": "326569316",
            "telephone_number": "570-352-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 AJAX STREET BRANCH HEALTH CLINIC - PRIMARY CARE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322143752",
            "telephone_number": "302-353-8471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5629 State Road 16 W Bldg 2127",
            "address_purpose": "LOCATION",
            "city": "Starke",
            "state": "FL",
            "postal_code": "320919791",
            "country_code": "US",
            "telephone_number": "904-682-4404",
            "fax_number": "904-214-7490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARCKE",
        "first_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0000655",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9113754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.