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General NPI Number Information
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NPI Number | 1417500786
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Entity Type | Individual
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Provider Name | SUZANNE RENEE TAMBASCO NP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 210 TRILITH PKWY
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4616
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Country | US
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Telephone | 770-309-5891
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Fax |
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Provider Business Mailing Address
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Address Line | 2870 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30305-2918
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Country | US
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Telephone | 770-309-5891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 155955
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 259122
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 24185688
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 114662
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11022333
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0002821
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License Number State | CO
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202102650
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License Number State | OR
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP-63745
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License Number State | NM
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