Provider Demographics
NPI:1386154615
Name:DEREN, SUSAN R (RN, LMT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:DEREN
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 S BELCHER RD STE 124
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3903
Mailing Address - Country:US
Mailing Address - Phone:727-560-6103
Mailing Address - Fax:
Practice Address - Street 1:50 S BELCHER RD STE 124
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3903
Practice Address - Country:US
Practice Address - Phone:727-560-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9193476163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse