MEDICARE: JACINTA ANEKWE 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
1	363LF0000X	Family Nurse Practitioner	RN223904	GA

General Provider Information

NPI Number	:	1538692348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACINTA ANEKWE FNP

Provider Business Mailing Address
First Line	:	3270 WALTON RIVERWOOD LN SE
Second Line	:	APT 2004
City	:	ATLANTA
State	:	GA
Zip	:	30339-3561
Country	:	US
Telephone Number	:	219-588-9969
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 WALTON RIVERWOOD LN SE
Second Line	:	APT 2004
City	:	ATLANTA
State	:	GA
Zip	:	30339-3561
Country	:	US
Telephone Number	:	219-588-9969
Fax Number	:

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

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	04/07/2017

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