Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN219744 | GA |
NPI | 1013680172 |
---|---|
Provider Name | Stephanie Garrett Intorcia |
First Address | Macon, GA 31201-3262 |
Second Address | Macon, GA 31201-3294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 31/08/2021 |