Provider Demographics
NPI:1841391869
Name:GASQUE, SUSAN R (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:GASQUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ROBLEDO
Other - Last Name:POUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:STE 175
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6403
Mailing Address - Country:US
Mailing Address - Phone:615-988-2014
Mailing Address - Fax:615-208-1303
Practice Address - Street 1:14821 DAYTON PIKE
Practice Address - Street 2:STE B
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373-5752
Practice Address - Country:US
Practice Address - Phone:423-497-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1083187363L00000X
TN12850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1326373861OtherGROUP NPI