Provider Demographics
NPI:1376703405
Name:CROUCH, SUSANNA RAE (APRN-BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:RAE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:APRN-BC, FNP
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Mailing Address - Street 1:2341 MCCALLIE AVENUE. PLAZA 3, STE. 406
Mailing Address - Street 2:GASTROENTEROLOGY ASSOCIATES OF CHATTANOOGA, PC
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3229
Mailing Address - Country:US
Mailing Address - Phone:423-648-8204
Mailing Address - Fax:423-493-1908
Practice Address - Street 1:2341 MCCALLIE AVENUE. PLAZA 3, STE. 406.
Practice Address - Street 2:GASTROENTEROLOGY ASSOCIATES OF CHATTANOOGA, PC
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3229
Practice Address - Country:US
Practice Address - Phone:423-648-8204
Practice Address - Fax:423-493-1908
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN13252APNFNP363LF0000X
TN13252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I503608OtherMEDICARE PTAN