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General NPI Number Information
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NPI Number | 1760071484
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Entity Type | Individual
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Provider Name | ANGELIQUE LACAVERA DNP-FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 800 E WEST CONNECTOR
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City | AUSTELL
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State | GA
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Zip | 30106-1358
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Country | US
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Telephone | 770-438-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 209 COOLEY DR STE 100
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City | VILLA RICA
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State | GA
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Zip | 30180-7057
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Country | US
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Telephone | 770-456-0911
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN257986
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-AP257986
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License Number State | GA
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