Provider Demographics
NPI:1174519227
Name:SHIBLA, SUZAN ELIZABETH (CFNP)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:ELIZABETH
Last Name:SHIBLA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:SUZAN
Other - Middle Name:ELIZABETH
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1710
Mailing Address - Country:US
Mailing Address - Phone:703-391-2020
Mailing Address - Fax:703-391-1211
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:703-391-1211
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015455F32Medicare ID - Type Unspecified
Q30767Medicare UPIN