Provider Demographics
NPI:1871810309
Name:CARRASQUILLO, SUZIE
Entity type:Individual
Prefix:
First Name:SUZIE
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZIE
Other - Middle Name:
Other - Last Name:LACOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 DERBY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-6717
Mailing Address - Country:US
Mailing Address - Phone:845-480-9555
Mailing Address - Fax:
Practice Address - Street 1:99 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-2417
Practice Address - Country:US
Practice Address - Phone:860-874-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44017164W00000X
NY292495164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse