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General NPI Number Information
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NPI Number | 1902614647
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Entity Type | Individual
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Provider Name | SOFIA GERAGHTY PNP-AC
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Gender | Female
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 1000 BLYTHE BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5812
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Country | US
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Telephone | 704-381-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 15161 JENELL ST
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City | POWAY
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State | CA
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Zip | 92064-2615
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Country | US
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Telephone | 786-656-1564
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 5021415
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License Number State | NC
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