Provider Demographics
NPI:1558047969
Name:SUAREZ, THANIA MARI (RN)
Entity Type:Individual
Prefix:
First Name:THANIA
Middle Name:MARI
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 LAKE ACWORTH DR NW # H
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7358
Mailing Address - Country:US
Mailing Address - Phone:770-575-0679
Mailing Address - Fax:
Practice Address - Street 1:6060 LAKE ACWORTH DR NW # H
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7358
Practice Address - Country:US
Practice Address - Phone:770-575-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081072163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty