Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN231323 | GA |
NPI | 1073107512 |
---|---|
Provider Name | Mrs. Paige R Cocco |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2021 |
Last Update Date | 01/04/2021 |