Susan C Wilson, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11019679 Issued in FL

Practice address

802 2ND St N
Suite B
Safety Harbor, FL 34695

Phone

(352) 345-0530

NPI assigned

May 19, 2022

Reactivated

Mar 15, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772150400000",
    "number": "1104563105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 2ND ST N STE B",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346953566",
            "telephone_number": "352-345-0530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 2ND ST N",
            "address_2": "SUITE B",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "34695",
            "telephone_number": "352-345-0530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SUSAN",
        "middle_name": "C",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-19",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "deactivation_date": "2024-01-29",
        "reactivation_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11019679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Caleb Wiley
• Aaron T Williams, MD
• Millie Ann Williams, L.C.S.W.
• Lena Marie Willis, FNP-BC
• Michael Jeffrey Wilson, A.R.N.P.
• Allison Winfree, CSA
• Nicole Marie Winter, APRN
• Womens Care Florida LLP
• Rebecca Xenakis
• Summer Yandek, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Safety Harbor, FL
• Providers in Safety Harbor, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.