Healthcare Provider Details

I. General information

NPI: 1942707161
Provider Name (Legal Business Name): SUZETTE REBECCA HOLDER DNP, AGPCNP, CNS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZETTE REBECCA RYAN DNP, AGPCNP-C, AGCNS

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 LOUISIANA AVENUE
BROOKLYN NY
11239
US

IV. Provider business mailing address

1009 E 86TH ST APT 3
BROOKLYN NY
11236-4290
US

V. Phone/Fax

Practice location:
  • Phone: 718-669-7100
  • Fax: 718-669-7547
Mailing address:
  • Phone: 917-402-7374
  • Fax: 718-669-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number599546
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number559546-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number599546-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF308644-1
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308644-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: