MEDICARE: LUCIA V OCANOVICIU NP-C

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	363LP2300X	Primary Care Nurse Practitioner	RN234135	GA

General Provider Information

NPI Number	:	1659765832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA V OCANOVICIU NP-C

Provider Business Mailing Address
First Line	:	320 HOSPITAL RD
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2432
Country	:	US
Telephone Number	:	770-479-5535
Fax Number	:	770-479-8821

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 300
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8019
Country	:	US
Telephone Number	:	770-721-9630
Fax Number	:	770-721-9631

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	04/29/2020

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