MEDICARE: SUZANNE ROY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95029820	CA

General Provider Information

NPI Number	:	1265271399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE ROY FNP

Provider Business Mailing Address
First Line	:	36 MARISOL ST
Second Line	:
City	:	RANCHO MISSION VIEJO
State	:	CA
Zip	:	92694-1393
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 NEWPORT CENTER DR STE 301
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7604
Country	:	US
Telephone Number	:	949-644-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	05/20/2024

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