Provider Demographics
NPI:1104989185
Name:CARNILL, SUZANNE GANZAK (LMT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:GANZAK
Last Name:CARNILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SANDOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-5144
Mailing Address - Country:US
Mailing Address - Phone:850-235-2672
Mailing Address - Fax:
Practice Address - Street 1:127 SANDOLLAR DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5144
Practice Address - Country:US
Practice Address - Phone:850-235-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35289174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist