Healthcare Provider Details

I. General information

NPI: 1760071484
Provider Name (Legal Business Name): ANGELIQUE LACAVERA DNP-FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E WEST CONNECTOR
AUSTELL GA
30106-1358
US

IV. Provider business mailing address

209 COOLEY DR STE 100
VILLA RICA GA
30180-7057
US

V. Phone/Fax

Practice location:
  • Phone: 770-438-1680
  • Fax:
Mailing address:
  • Phone: 770-456-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN257986
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-AP257986
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: