Provider Demographics
NPI:1215181961
Name:PHILCOX, SUSAN LYNCH (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNCH
Last Name:PHILCOX
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 SW FENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2303
Mailing Address - Country:US
Mailing Address - Phone:561-313-2807
Mailing Address - Fax:
Practice Address - Street 1:1080 SW FENWAY RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2303
Practice Address - Country:US
Practice Address - Phone:561-313-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012761363LF0000X
NDR55827363LF0000X, 363LP0808X
MN10156363LF0000X
IL209.026533363LF0000X
UT13853583-4405363LF0000X, 363LP0808X
MS906597363LF0000X
OK217339363LF0000X
SDCP003192363LF0000X
NJ26NJI5079700363LF0000X
FLAPRN9195037363LP0808X
RI04030363LF0000X
FL9195037363LF0000X
DEL8-0010645363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000562300Medicaid
FLY135XOtherBCBS
FLAY307ZMedicare PIN