Individual
SOUSAN YAZDI BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
8931 COLONIAL CENTER DR, SUITE 300, FORT MYERS, FL 33905-7809
(239) 938-0800
(239) 938-0890
Mailing address
4371 VERONICA S SHOEMAKER BLVD, ATTN: CREDENTIALING, FORT MYERS, FL 33916-2216
(239) 274-8200
(239) 278-3350
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9293083
FL
Other
Enumeration date
05/23/2014
Last updated
05/23/2014
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