Provider Demographics
NPI:1720371826
Name:SUICO, CAROL A (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:SUICO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:DEBRUZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46061-0220
Mailing Address - Country:US
Mailing Address - Phone:317-776-7149
Mailing Address - Fax:317-776-7433
Practice Address - Street 1:865 WESTFIELD RD
Practice Address - Street 2:STE C
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8901
Practice Address - Country:US
Practice Address - Phone:317-776-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000743A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner