Provider Demographics
NPI:1538936802
Name:ALBA-PADRON, SUSANNAH MARRISA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSANNAH
Middle Name:MARRISA
Last Name:ALBA-PADRON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-9792
Mailing Address - Country:US
Mailing Address - Phone:361-232-1909
Mailing Address - Fax:
Practice Address - Street 1:2882 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-4106
Practice Address - Country:US
Practice Address - Phone:361-814-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health