Provider Demographics
NPI:1134663479
Name:MUSSACHIO, SUSAN (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MUSSACHIO
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W 15TH ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5841
Mailing Address - Country:US
Mailing Address - Phone:972-596-5222
Mailing Address - Fax:972-596-5291
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:STE 245
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:972-596-5222
Practice Address - Fax:972-596-5291
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX560320YL7AMedicare PIN
TX560320YNGSMedicare PIN
TX560320YL7BMedicare PIN