Provider Demographics
NPI:1225297666
Name:GROOMS, SUZANNE M (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:GROOMS
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:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-0881
Mailing Address - Fax:901-516-0528
Practice Address - Street 1:8035 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5977
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-758-6060
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4346669OtherBCBS
TN4346669OtherBCBS