Healthcare Provider Details

I. General information

NPI: 1801411939
Provider Name (Legal Business Name): NANCY KATIANA SUAREZ-TIPTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY KATIANA SUAREZ

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

IV. Provider business mailing address

169 ASHLEY AVE RM 202
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0192
  • Fax:
Mailing address:
  • Phone: 843-792-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMMD.84533
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: