Healthcare Provider Details

I. General information

NPI: 1851932115
Provider Name (Legal Business Name): AMANDA SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 06/20/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 E 46TH PL
TULSA OK
74145-6305
US

IV. Provider business mailing address

7477 E 46TH PL
TULSA OK
74145-6305
US

V. Phone/Fax

Practice location:
  • Phone: 918-384-0002
  • Fax: 918-384-0004
Mailing address:
  • Phone: 918-384-0002
  • Fax: 918-384-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4541
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: