Provider Demographics
NPI:1801886726
Name:PASSERETTI, SUSANNE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:MARIE
Last Name:PASSERETTI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 NESTLING CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-494-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1793542363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3055922-00Medicaid
P00131636OtherRAILROAD MEDICARE
FLY026WOtherFLORIDA BLUE CROSS BLUE SHIELD
590-88943OtherALABAMA BLUE CROSS BLUE SHIELD
FL3055922-00Medicaid
590-88943OtherALABAMA BLUE CROSS BLUE SHIELD