Provider Demographics
NPI:1407068653
Name:ROBERSON, SUSAN CAROL (CFNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:STE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-284-4680
Mailing Address - Fax:615-284-4681
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:STE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-284-4680
Practice Address - Fax:615-284-4681
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714571OtherGROUP ID NUMBER
TN3649570Medicare ID - Type Unspecified
TNQ33640Medicare UPIN