Provider Demographics
NPI:1730724451
Name:DRAGINIS, SUZANA (FPA-APRN, AGNP,IFMCP)
Entity type:Individual
Prefix:
First Name:SUZANA
Middle Name:
Last Name:DRAGINIS
Suffix:
Gender:F
Credentials:FPA-APRN, AGNP,IFMCP
Other - Prefix:
Other - First Name:SUZANA
Other - Middle Name:
Other - Last Name:NIKITOVIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FPA-APRN, AGNP-C
Mailing Address - Street 1:825 S WAUKEGAN RD STE A8
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2665
Mailing Address - Country:US
Mailing Address - Phone:815-405-7137
Mailing Address - Fax:833-800-0135
Practice Address - Street 1:825 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2696
Practice Address - Country:US
Practice Address - Phone:815-405-7137
Practice Address - Fax:833-800-0135
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.003847363LA2200X
IL041.300079363LP2300X
IL209.021082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277.003847OtherSTATE OF ILLINOIS FULL PRACTICE AUTHORITY