Provider Demographics
NPI:1386891059
Name:SUZANNE, TAMERA S (PNP)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:S
Last Name:SUZANNE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:TAMERA
Other - Middle Name:S
Other - Last Name:SUZANNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:300 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1118
Mailing Address - Country:US
Mailing Address - Phone:585-637-3905
Mailing Address - Fax:585-637-4990
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1933
Practice Address - Country:US
Practice Address - Phone:607-590-2424
Practice Address - Fax:607-590-2428
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559530-1364SP0200X
NY382025363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics