Provider Demographics
NPI:1295766699
Name:DIBONA, SUZANNE (CRNA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DIBONA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652
Mailing Address - Country:US
Mailing Address - Phone:727-845-1736
Mailing Address - Fax:727-849-0759
Practice Address - Street 1:6600 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-1971
Practice Address - Country:US
Practice Address - Phone:727-842-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1428412367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62382ZMedicare ID - Type Unspecified