Individual provider Active NPI

Susan L. Moran, APRN, BC

  • Adult Health Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1629263249
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
9256516 Issued in FL
Practice address
15051 Shell Point Blvd
Fort Myers, FL 33908
Phone
(239) 466-1111
NPI assigned
Sep 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 9256516 FL Primary

Addresses

Primary practice location

15051 Shell Point Blvd
Fort Myers, FL 33908

Mailing address

15000 Shell Point Blvd Ste 100
Fort Myers, FL 33908-1657

Other practice location 1

13751 Metropolis Ave
Fort Myers, FL 33912
Phone (210) 780-7788

Other practice location 2

15071 Shell Point Blvd
Fort Myers, FL 33908-1639
Phone (239) 415-5477

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9256516FLMDAdult Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1629263249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15000 SHELL POINT BLVD STE 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339081657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15051 SHELL POINT BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-466-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13751 Metropolis Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "33912",
            "country_code": "US",
            "telephone_number": "210-780-7788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15071 Shell Point Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339081639",
            "country_code": "US",
            "telephone_number": "239-415-5477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "SUSAN",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "APRN, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-06",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "9256516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.