Provider Demographics
NPI:1578914081
Name:SMITH, SUZANNE SISSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:SISSON
Last Name:SMITH
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 1:838 OLD GEORGE WASHINGTON HWY N STE T&U
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2209
Mailing Address - Country:US
Mailing Address - Phone:757-389-7631
Mailing Address - Fax:757-966-5895
Practice Address - Street 1:838 OLD GEORGE WASHINGTON HWY N STE T&U
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2209
Practice Address - Country:US
Practice Address - Phone:757-389-7631
Practice Address - Fax:757-966-5895
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily