Healthcare Provider Details

I. General information

NPI: 1215859764
Provider Name (Legal Business Name): HALYNA HNIDETS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W WIEUCA RD NE STE 60891
ATLANTA GA
30342-3321
US

IV. Provider business mailing address

285 W WIEUCA RD NE STE 60891
ATLANTA GA
30342-3321
US

V. Phone/Fax

Practice location:
  • Phone: 678-753-4633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number272822
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: