Provider Demographics
NPI:1942707161
Name:HOLDER, SUZETTE REBECCA (DNP, AGPCNP, CNS, RN)
Entity type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:REBECCA
Last Name:HOLDER
Suffix:
Gender:F
Credentials:DNP, AGPCNP, CNS, RN
Other - Prefix:DR
Other - First Name:SUZETTE
Other - Middle Name:REBECCA
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, AGPCNP-C, AGCNS
Mailing Address - Street 1:1009 E 86TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4290
Mailing Address - Country:US
Mailing Address - Phone:917-402-7374
Mailing Address - Fax:718-669-7547
Practice Address - Street 1:660 LOUISIANA AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239
Practice Address - Country:US
Practice Address - Phone:718-669-7100
Practice Address - Fax:718-669-7547
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599546163W00000X
NY559546-1163W00000X
NY599546-1364S00000X
NYF308644-1363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner