Provider Demographics
NPI:1093931719
Name:EARL, SUSAN D (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
Last Name:EARL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 W POPLAR AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2582
Mailing Address - Country:US
Mailing Address - Phone:901-221-8621
Mailing Address - Fax:901-221-8631
Practice Address - Street 1:890 W POPLAR AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2582
Practice Address - Country:US
Practice Address - Phone:901-221-8621
Practice Address - Fax:901-221-8631
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12687363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care