Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN187984 | GA |
NPI | 1497185441 |
---|---|
Provider Name | Jessica Hinton Vincent |
First Address | Atlanta, GA 30317-2615 |
Second Address | Atlanta, GA 30303-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2013 |
Last Update Date | 27/04/2017 |