=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558534768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEOVANNA DEESE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2008
-----------------------------------------------------
Last Update Date | 01/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 BILLINGSLEY RD STE 200
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-1180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-372-7974
-----------------------------------------------------
Fax | 704-372-8201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3426 TORINGDON WAY STE 108
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-3497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-372-7974
-----------------------------------------------------
Fax | 704-970-4746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5003955
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------