Individual
SUSAN W LLARENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1340 S 18TH ST, #204, FERNANDINA BEACH, FL 32034-4799
(904) 261-0643
(904) 277-4082
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 2061
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NJ448
MEDICARE
FL
Enumeration date
07/26/2006
Last updated
03/18/2021
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