MEDICARE: SUZANNE CLARK GARCIA NP

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	R164221	MD
2	363LF0000X	Family Nurse Practitioner	0024166316	VA

General Provider Information

NPI Number	:	1285722629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE CLARK GARCIA NP

Provider Business Mailing Address
First Line	:	1515 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-1735
Country	:	US
Telephone Number	:	410-396-9410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 W NORTH AVE FL 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-1735
Country	:	US
Telephone Number	:	410-396-0176
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	01/27/2022

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