Provider Demographics
NPI:1952428146
Name:CSORNA, SUZANNE TERESA (MSN, APRN)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:TERESA
Last Name:CSORNA
Suffix:
Gender:F
Credentials:MSN, APRN
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:653-1 W 8TH ST # L17
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-3109
Mailing Address - Fax:904-244-3658
Practice Address - Street 1:880 CRESTMARK DR
Practice Address - Street 2:STE 200
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2646
Practice Address - Country:US
Practice Address - Phone:770-941-8662
Practice Address - Fax:770-739-6006
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005971363LA2200X, 363LW0102X
TN12596363LA2200X
TNAPN12596363LW0102X
GARN248574363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN248574OtherGA NP AND RN LICENSE NUMBER
GA58-1397572OtherBUSINESS TAX ID