Healthcare Provider Details

I. General information

NPI: 1689219388
Provider Name (Legal Business Name): MARINA TARABICOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-550-1972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN267732
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number267732
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number267732
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: