Provider Demographics
NPI:1891981478
Name:GILBERT, SUSAN A (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:GILBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 CENTERVIEW PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4289
Mailing Address - Country:US
Mailing Address - Phone:901-751-4112
Mailing Address - Fax:901-751-9878
Practice Address - Street 1:8000 CENTERVIEW PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4289
Practice Address - Country:US
Practice Address - Phone:901-751-4112
Practice Address - Fax:901-751-9878
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868795363LF0000X
TNAPN6104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I506040Medicare PIN
MS302I508354Medicare PIN