Provider Demographics
NPI:1437308830
Name:COPPOLA, SUZANNE PATRICIA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:PATRICIA
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17946 W NORTH LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-4254
Mailing Address - Country:US
Mailing Address - Phone:602-769-1011
Mailing Address - Fax:
Practice Address - Street 1:17946 W NORTH LN
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-4254
Practice Address - Country:US
Practice Address - Phone:602-769-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily