Healthcare Provider Details

I. General information

NPI: 1902614647
Provider Name (Legal Business Name): SOFIA GERAGHTY PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

15161 JENELL ST
POWAY CA
92064-2615
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-2000
  • Fax:
Mailing address:
  • Phone: 786-656-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number5021415
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: