Provider Demographics
NPI:1326148495
Name:SU, TUY T (PA-C)
Entity Type:Individual
Prefix:
First Name:TUY
Middle Name:T
Last Name:SU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TUY
Other - Middle Name:THI
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 N E ST STE 430
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6345
Mailing Address - Country:US
Mailing Address - Phone:850-437-8711
Mailing Address - Fax:850-437-8719
Practice Address - Street 1:1717 N E ST STE 430
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6345
Practice Address - Country:US
Practice Address - Phone:850-437-8711
Practice Address - Fax:850-437-8719
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004799363A00000X
FLPA9110728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023794800Medicaid
MI382285194OtherTAX ID
MIQ72301Medicare UPIN