MEDICARE: MRS. ELIZABETH ANN CERCONE NP, RN

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	163W00000X	Registered Nurse	RN213895	GA
2	163W00000X	Registered Nurse	2727652	FL
3	363LF0000X	Family Nurse Practitioner	RN213895	GA

General Provider Information

NPI Number	:	1821335993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN CERCONE NP, RN

Provider Business Mailing Address
First Line	:	3505 DULUTH PARK LN STE 400
Second Line	:	MAXA INTERNAL MEDICINE ASSOCIATES
City	:	DULUTH
State	:	GA
Zip	:	30096-3203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 DULUTH PARK LN STE 400
Second Line	:	MAXA INTERNAL MEDICINE ASSOCIATES
City	:	DULUTH
State	:	GA
Zip	:	30096-3203
Country	:	US
Telephone Number	:	678-597-3180
Fax Number	:

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	08/03/2015

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