Provider Demographics
NPI:1992079701
Name:HAINES, SUSAN FULTON (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FULTON
Last Name:HAINES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:FULTON
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1186 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2479
Mailing Address - Country:US
Mailing Address - Phone:321-779-3370
Mailing Address - Fax:321-622-8616
Practice Address - Street 1:1186 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2479
Practice Address - Country:US
Practice Address - Phone:321-779-3370
Practice Address - Fax:321-622-8616
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9220722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily