Healthcare Provider Details

I. General information

NPI: 1376571778
Provider Name (Legal Business Name): SUZZAN M TARNO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZZAN M NELSON CRNP

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/02/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S 104TH AVE
TOLLESON AZ
85353-9236
US

IV. Provider business mailing address

409 S 104TH AVE
TOLLESON AZ
85353-9236
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-1846
  • Fax: 623-907-1847
Mailing address:
  • Phone: 623-907-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-084184
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number247230
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: