Provider Demographics
NPI:1891761144
Name:DUBECK, SUZANNE ANDREA (PNP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ANDREA
Last Name:DUBECK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OTIS SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8940
Mailing Address - Country:US
Mailing Address - Phone:931-553-6666
Mailing Address - Fax:
Practice Address - Street 1:111 OTIS SMITH DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8940
Practice Address - Country:US
Practice Address - Phone:931-553-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000112635363LP0200X
TNAPN0000007482363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022026Medicaid