Susan Ann Wallace

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

ARNP3262052 Issued in FL

Practice address

17501 Dale Mabry Hwy N
Lutz, FL 33548-4521

Phone

(813) 962-1000

NPI assigned

Dec 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Susan Ann Hayman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

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.

• West Central Gastroenterology LLP

  • Gastroenterology Physician
  • Clearwater, FL
  • NPI 1144454703
  NPD (past)
• West Florida Medical Specialists PA

  • Gastroenterology Physician
  • New Port Richey, FL
  • NPI 1568590719
  NPD (past)

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198627200000",
    "number": "1104000199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17501 DALE MABRY HWY N",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484521",
            "telephone_number": "813-962-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17501 DALE MABRY HWY N",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484521",
            "telephone_number": "813-962-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SUSAN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-26",
        "last_updated": "2007-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP3262052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "HAYMAN",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "ARNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walgreens
• Walk N Wellness, LLC
• John Walker
• Unique Walker
• Christina M Wallace, LCSW
• Jessica Walterhoefer, APRN
• Kerie Walters
• Monica Ward
• Ariana Nicole Warner
• Jamia Washington

• Adult Health Nurse Practitioner in Lutz, FL
• Providers in Lutz, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.