Individual provider Active NPI

Susan Phillips Vaughen, ARNP CNM

  • Advanced Practice Midwife
  • Lake Mary, FL
National Provider Identifier
1174528830
Registry record updated Feb 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
ARNP2011692 Issued in FL
Practice address
785 Primera Blvd
Suite 1031
Lake Mary, FL 32746-2124
Phone
(407) 834-8111
Fax
(407) 708-1958
NPI assigned
Jun 17, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X ARNP2011692 FL Primary

Addresses

Primary practice location

785 Primera Blvd
Suite 1031
Lake Mary, FL 32746-2124

Mailing address

785 Primera Blvd
Suite 1031
Lake Mary, FL 32746-2124
Phone (407) 834-8111

Other identifiers 1

IdentifierTypeStateIssuer
304590100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP2011692FLMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Womencare PA Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266451200000",
    "number": "1174528830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 PRIMERA BLVD",
            "address_2": "SUITE 1031",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462124",
            "telephone_number": "407-834-8111",
            "fax_number": "407-708-1958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 PRIMERA BLVD",
            "address_2": "SUITE 1031",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462124",
            "telephone_number": "407-834-8111",
            "fax_number": "407-708-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHEN",
        "first_name": "SUSAN",
        "middle_name": "PHILLIPS",
        "name_prefix": "Ms.",
        "credential": "ARNP CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-17",
        "last_updated": "2010-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "FL",
            "license": "ARNP2011692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304590100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.