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NPI Code Detail

MEDICARE: PATRENA CODY FNP

MEDICARE: PATRENA CODY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerRN03147GA
2363LS0200XSchool Nurse PractitionerRN03147GA

General Provider Information

NPI Number : 1205531878
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRENA CODY FNP
Provider Business Mailing Address
First Line : 5296 AURORA CT SW
Second Line :
City : LILBURN
State : GA
Zip : 30047-6302
Country : US
Telephone Number : 770-885-9986
Fax Number :
Provider Business Practice Location Address
First Line : 500 WASHINGTON ST SE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3628
Country : US
Telephone Number : 770-534-6135
Fax Number : 770-534-6122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2023
Last Update Date : 04/03/2023

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