Provider Demographics
NPI:1992525422
Name:NOEL, SUZETTE TAN (APRN)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:TAN
Last Name:NOEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 SW LUGANO CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-0089
Mailing Address - Country:US
Mailing Address - Phone:352-665-0952
Mailing Address - Fax:
Practice Address - Street 1:6608 SW LUGANO CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-0089
Practice Address - Country:US
Practice Address - Phone:352-665-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner