Provider Demographics
NPI:1679655310
Name:RUSH, CARA SUZANNE (PA)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:SUZANNE
Last Name:RUSH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CARILLON PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1115
Mailing Address - Country:US
Mailing Address - Phone:727-573-5626
Mailing Address - Fax:727-573-5627
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-573-5626
Practice Address - Fax:727-573-5627
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102099363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8464Medicare ID - Type Unspecified