Provider Demographics
NPI:1215516992
Name:HOWARD, SUSSANA ETAROCK (NP)
Entity type:Individual
Prefix:MS
First Name:SUSSANA
Middle Name:ETAROCK
Last Name:HOWARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SUSSANA
Other - Middle Name:MBI
Other - Last Name:ETAROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:325 LONGSHORE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5486
Mailing Address - Country:US
Mailing Address - Phone:469-650-7946
Mailing Address - Fax:
Practice Address - Street 1:325 LONGSHORE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5486
Practice Address - Country:US
Practice Address - Phone:469-650-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023717363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health