Provider Demographics
NPI:1417184482
Name:SILVA, SUZANNE E (PA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:SILVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:E
Other - Last Name:FOLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1900 HOLLISTER DR
Mailing Address - Street 2:STE 250
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5249
Mailing Address - Country:US
Mailing Address - Phone:847-573-9663
Mailing Address - Fax:
Practice Address - Street 1:342 FREY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1734
Practice Address - Country:US
Practice Address - Phone:615-792-1199
Practice Address - Fax:615-792-9331
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525560Medicaid
TN1525560Medicaid