Provider Demographics
NPI:1811293087
Name:PITRUZZELLO, SUSANNA ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:ELIZABETH
Last Name:PITRUZZELLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD.
Practice Address - Street 2:B BLDG., T LEVEL
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3764
Practice Address - Country:US
Practice Address - Phone:251-625-6896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1102256207RH0003X
AL1-102256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130124Medicaid
AL212689Medicaid
ALP02453782OtherRAILROAD MEDICARE
AL102I506543OtherMEDICARE PTAN