Healthcare Provider Details

I. General information

NPI: 1154912251
Provider Name (Legal Business Name): ELIZABETH AMBROS SUAREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6063 MT. MORIAH EXT. SUITE 100
MEMPHIS TN
38115-2644
US

IV. Provider business mailing address

6625 LENOX PARK DR STE 202
MEMPHIS TN
38115-8200
US

V. Phone/Fax

Practice location:
  • Phone: 901-531-8800
  • Fax: 901-531-8801
Mailing address:
  • Phone: 901-683-0024
  • Fax: 901-683-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4445
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: