Provider Demographics
NPI:1598034886
Name:ELDRIDGE, SUSAN WOOLLEN (PNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WOOLLEN
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:WOOLLEN
Other - Last Name:FIGUEROA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:2550 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4310
Mailing Address - Country:US
Mailing Address - Phone:850-522-1522
Mailing Address - Fax:850-522-5925
Practice Address - Street 1:2550 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4310
Practice Address - Country:US
Practice Address - Phone:850-522-1522
Practice Address - Fax:850-522-5925
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024569363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics