Provider Demographics
NPI:1780932111
Name:FOX, EMILY SUZANNE (CPNP-AC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SUZANNE
Last Name:FOX
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-1615
Mailing Address - Fax:
Practice Address - Street 1:1438 MCLENDON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1802
Practice Address - Country:US
Practice Address - Phone:770-414-0337
Practice Address - Fax:855-294-1992
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC158599363LA2100X, 363LP0200X, 363LP0222X
GARN183389363LP0200X
TX818700363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care