Healthcare Provider Details

I. General information

NPI: 1386891059
Provider Name (Legal Business Name): TAMERA S. SUZANNE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMERA S. SUZANNE PNP

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ELM ST LOWER LEVEL
HORNELL NY
14843-1933
US

IV. Provider business mailing address

300 WEST AVE
BROCKPORT NY
14420-1118
US

V. Phone/Fax

Practice location:
  • Phone: 607-590-2424
  • Fax: 607-590-2428
Mailing address:
  • Phone: 585-637-3905
  • Fax: 585-637-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382025
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number559530-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: