Healthcare Provider Details

I. General information

NPI: 1205531878
Provider Name (Legal Business Name): PATRENA CODY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WASHINGTON ST SE
GAINESVILLE GA
30501-3628
US

IV. Provider business mailing address

5296 AURORA CT SW
LILBURN GA
30047-6302
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-6135
  • Fax: 770-534-6122
Mailing address:
  • Phone: 770-885-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN03147
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN03147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: