Individual
SUSAN E. KENNEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP9271737
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001189900
—
FL
01
—
Y00F8
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/03/2009
Last updated
11/13/2009
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