Provider Demographics
NPI:1710859780
Name:SUAREZ, NICOLE MARIE (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 E BREEZY CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-5313
Mailing Address - Country:US
Mailing Address - Phone:480-291-3314
Mailing Address - Fax:
Practice Address - Street 1:1416 E BREEZY CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-5313
Practice Address - Country:US
Practice Address - Phone:480-291-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2000621949363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty