Provider Demographics
NPI:1942963335
Name:PASCO, SUZANNE MARIETTE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIETTE
Last Name:PASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKE WOODWARD DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-7373
Mailing Address - Country:US
Mailing Address - Phone:352-205-2871
Mailing Address - Fax:
Practice Address - Street 1:4700 THAT ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9723
Practice Address - Country:US
Practice Address - Phone:352-326-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10210973363LF0000X
FLAPRN11016300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily