Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN202316 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN202316 | GA |
NPI | 1023550696 |
---|---|
Provider Name | Miss Antranika D. Ross |
First Address | Mcdonough, GA 30253-4703 |
Second Address | Lake City, GA 30260-3944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2016 |
Last Update Date | 27/12/2020 |