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General NPI Number Information
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NPI Number | 1639479264
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Entity Type | Individual
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Provider Name | SUSAN NOLAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1156 NASHVILLE PIKE
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City | GALLATIN
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State | TN
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Zip | 37066-3110
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Country | US
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Telephone | 615-989-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 COLDSTREAM LN
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City | NAPLES
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State | FL
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Zip | 34104-4736
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Country | US
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Telephone | 239-273-4967
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2671
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4724
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License Number State | TN
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