MEDICARE: JUANITA NORRIS CPNP

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
1	363LP0200X	Pediatric Nurse Practitioner	75091	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285627372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA NORRIS CPNP

Provider Business Mailing Address
First Line	:	274 BIG A RD
Second Line	:
City	:	TOCCOA
State	:	GA
Zip	:	30577-6002
Country	:	US
Telephone Number	:	706-886-8419
Fax Number	:	706-886-4479

Provider Business Practice Location Address
First Line	:	58 BIG A ROAD
Second Line	:
City	:	TOCCOA
State	:	GA
Zip	:	30577-6017
Country	:	US
Telephone Number	:	706-886-8419
Fax Number	:	706-886-4479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/20/2019

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