Individual
MRS. SUSAN BAUER O'TOOLE-EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 AVENUE K SE STE 6, WINTER HAVEN, FL 33880-4123
(863) 299-4567
(863) 297-9750
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4100
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME57743
FL
208000000X
Pediatrics Physician
ME57743
FL
208D00000X
General Practice Physician
Primary
ME57743
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063869200
—
FL
01
—
ME57743
MEDICAL LICENSE NUMBER
FL
Enumeration date
10/19/2006
Last updated
04/26/2019
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