Basic Information
| Provider Information | |||||||||
| NPI: | 1891981478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 CENTERVIEW PKWY | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380184289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017514112 | ||||||||
| FaxNumber: | 9017519878 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 CENTERVIEW PKWY | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380184289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017514112 | ||||||||
| FaxNumber: | 9017519878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 05/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R868795 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | APN6104 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.