Provider Demographics
NPI:1225459852
Name:BADDOUR, SUEANNE ELIZABETH (DNP, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:SUEANNE
Middle Name:ELIZABETH
Last Name:BADDOUR
Suffix:
Gender:F
Credentials:DNP, APRN, FNP
Other - Prefix:
Other - First Name:SUEANNE
Other - Middle Name:ELIZABETH
Other - Last Name:FRATAMICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1309 COFFEEN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5777
Mailing Address - Country:US
Mailing Address - Phone:817-720-0150
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 4000
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:817-720-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2732363LF0000X
FLTPAN1807363LF0000X
TXAP125253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner