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General NPI Number Information
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NPI Number | 1679143515
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Entity Type | Individual
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Provider Name | VICTORIA POOL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 2462 HIGHWAY 34 E
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City | NEWNAN
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State | GA
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Zip | 30265-2372
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Country | US
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Telephone | 770-683-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 64 RESERVE PL
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City | SENOIA
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State | GA
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Zip | 30276-3539
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Country | US
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Telephone | 404-936-5877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN249149
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License Number State | GA
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