Provider Demographics
NPI:1053307504
Name:TUSSEY, SUSAN ROBERTA (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROBERTA
Last Name:TUSSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 CAMPUS AVE
Mailing Address - Street 2:#8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1127
Mailing Address - Country:US
Mailing Address - Phone:808-228-5661
Mailing Address - Fax:
Practice Address - Street 1:4525 CAMPUS AVE
Practice Address - Street 2:#8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116
Practice Address - Country:US
Practice Address - Phone:808-228-5661
Practice Address - Fax:808-257-5653
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003542B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily