Healthcare Provider Details

I. General information

NPI: 1972727204
Provider Name (Legal Business Name): CAROLYN MARIE SIRONEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 S ENOTA DR NE
GAINESVILLE GA
30501-2429
US

IV. Provider business mailing address

974 S ENOTA DR NE
GAINESVILLE GA
30501-2429
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-7546
  • Fax: 678-323-2006
Mailing address:
  • Phone: 770-536-7546
  • Fax: 678-323-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 1971362
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20277
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP001540
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: