Provider Demographics
NPI:1679015457
Name:SURI, DENISE HELEN
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:HELEN
Last Name:SURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8318
Mailing Address - Country:US
Mailing Address - Phone:850-434-6168
Mailing Address - Fax:
Practice Address - Street 1:1100 AIRPORT BLVD
Practice Address - Street 2:BLVD. B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8631
Practice Address - Country:US
Practice Address - Phone:850-434-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9365811363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health