Healthcare Provider Details

I. General information

NPI: 1407481864
Provider Name (Legal Business Name): NATHACHA LORQUET DNP, APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RIVERSIDE PKWY STE 107
LAWRENCEVILLE GA
30043-5926
US

IV. Provider business mailing address

2000 RIVERSIDE PKWY STE 107
LAWRENCEVILLE GA
30043-5926
US

V. Phone/Fax

Practice location:
  • Phone: 678-878-3215
  • Fax:
Mailing address:
  • Phone: 678-878-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberRN304596
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberRN304596
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberRN304596
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License NumberRN304596
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: