Healthcare Provider Details

I. General information

NPI: 1801597976
Provider Name (Legal Business Name): MARISA ESTRADA CALFEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA ROMERO ESTRADA

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

883 HIGHLAND AVE NW
CLEVELAND TN
37311-1837
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6158
  • Fax:
Mailing address:
  • Phone: 423-650-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number237734
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP001411
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: