Healthcare Provider Details

I. General information

NPI: 1841588712
Provider Name (Legal Business Name): PATRICIA NECOLE HUELSBECK NP-ADVANCED PRACTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S. ENOTA DRIVE SUITE #380
GAINESVILLE GA
30501-3473
US

IV. Provider business mailing address

1405 JESSE JEWELL PARKWAY
GAINESVILLE GA
30501-3086
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-7099
  • Fax: 770-219-7923
Mailing address:
  • Phone: 770-219-7099
  • Fax: 770-219-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN124420
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: