Provider Demographics
NPI:1336901362
Name:SUAREZ, SUZETTE MOLLENIDO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:MOLLENIDO
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 LAKE RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8147
Mailing Address - Country:US
Mailing Address - Phone:843-861-2120
Mailing Address - Fax:
Practice Address - Street 1:4011 LAKE RUSSELL DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8147
Practice Address - Country:US
Practice Address - Phone:843-861-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF06230876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily