Provider Demographics
NPI:1265549083
Name:WARE, SUZANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2817
Mailing Address - Country:US
Mailing Address - Phone:971-757-2100
Mailing Address - Fax:941-757-2101
Practice Address - Street 1:5534 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2817
Practice Address - Country:US
Practice Address - Phone:971-757-2100
Practice Address - Fax:941-757-2101
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001389363A00000X
FLPA9112865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106254200Medicaid
IAI11454Medicare ID - Type Unspecified