MEDICARE: MEREDITH PENNINO APRN, CPNP-PC

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	APRN11011883	FL
2	363LP0200X	Pediatric Nurse Practitioner	RN302421	GA

General Provider Information

NPI Number	:	1942894183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH PENNINO APRN, CPNP-PC

Provider Business Mailing Address
First Line	:	12460 CRABAPPLE RD # 202-277
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-6602
Country	:	US
Telephone Number	:	727-688-3138
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 MERCER UNIVERSITY DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-4145
Country	:	US
Telephone Number	:	770-458-3383
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/14/2022

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