Provider Demographics
NPI:1124659099
Name:RENTERIA, SUZANNA (AG-ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUZANNA
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16219 BONALVA
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4750
Mailing Address - Country:US
Mailing Address - Phone:210-535-5586
Mailing Address - Fax:
Practice Address - Street 1:16219 BONALVA
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4750
Practice Address - Country:US
Practice Address - Phone:210-535-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144261363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care