Healthcare Provider Details

I. General information

NPI: 1881192805
Provider Name (Legal Business Name): TAYANAU DEANN NUNEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALUMET PKWY BLDG F STE 201
NEWNAN GA
30263-6734
US

IV. Provider business mailing address

37 CALUMET PKWY BLDG F STE 201
NEWNAN GA
30263-6734
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-4538
  • Fax:
Mailing address:
  • Phone: 770-683-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN247788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: