Provider Demographics
NPI:1902887268
Name:SUZANNE K. ZOSS, PH.D., P.A.
Entity Type:Organization
Organization Name:SUZANNE K. ZOSS, PH.D., P.A.
Other - Org Name:SUZANNE K. ZOSS, PH.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-291-2568
Mailing Address - Street 1:1115 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6573
Mailing Address - Country:US
Mailing Address - Phone:850-291-2568
Mailing Address - Fax:850-435-7796
Practice Address - Street 1:4300 BAYOU BLVD
Practice Address - Street 2:SUITE 35
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1949
Practice Address - Country:US
Practice Address - Phone:850-479-6080
Practice Address - Fax:850-479-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73731XMedicare ID - Type Unspecified