Provider Demographics
NPI:1023580404
Name:SUAREZ BAS, ANNIE MARTHA (SA-C)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARTHA
Last Name:SUAREZ BAS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 N UNIVERSITY DR APT 101
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4030
Mailing Address - Country:US
Mailing Address - Phone:678-517-9386
Mailing Address - Fax:
Practice Address - Street 1:6701 N UNIVERSITY DR APT 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4030
Practice Address - Country:US
Practice Address - Phone:678-517-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-431246ZC0007X
FLAPRN11015051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant