Provider Demographics
NPI:1982023917
Name:VANACORE, SUZANNA LUCIA (NP)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:LUCIA
Last Name:VANACORE
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 1:1839 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8900
Mailing Address - Country:US
Mailing Address - Phone:727-322-1054
Mailing Address - Fax:727-322-2725
Practice Address - Street 1:445 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2735
Practice Address - Country:US
Practice Address - Phone:718-963-0800
Practice Address - Fax:718-534-5221
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9204428363LF0000X
NY342000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04877390Medicaid