MEDICARE: AKIYSHA COLLINS CAINE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	264610	GA

General Provider Information

NPI Number	:	1174141873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKIYSHA COLLINS CAINE FNP-BC

Provider Business Mailing Address
First Line	:	2200 SATELLITE BLVD APT 117
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4002
Country	:	US
Telephone Number	:	916-512-0227
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 SATELLITE BLVD APT 117
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4002
Country	:	US
Telephone Number	:	916-512-0227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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