Healthcare Provider Details

I. General information

NPI: 1699161513
Provider Name (Legal Business Name): ADRIANA ACOSTA-PROWS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 420
ROSWELL GA
30076-4919
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 420
ROSWELL GA
30076-4919
US

V. Phone/Fax

Practice location:
  • Phone: 770-410-4366
  • Fax: 770-410-4664
Mailing address:
  • Phone: 770-410-4366
  • Fax: 770-410-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP9220337
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN282393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: