Individual
FANISKA MASSILLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX 920095, NORCROSS, GA 30010-0095
(407) 308-9573
Mailing address
PO BOX 920095, NORCROSS, GA 30010-0095
(407) 308-9573
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
95030305
CA
363LF0000X
Family Nurse Practitioner
APRN11006594
FL
363LF0000X
Family Nurse Practitioner
Primary
F346372-01
NY
Other
Enumeration date
05/27/2020
Last updated
01/26/2025
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