Individual
MISS JANE PAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
116 SMITH ST, TENNILLE, GA 31089-1465
(478) 552-7384
(478) 864-1288
Mailing address
PO BOX 371, WRIGHTSVILLE, GA 31096-0371
(478) 864-3448
(478) 864-1288
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN052908
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN052908
GEORGIA LICENSE
GA
Enumeration date
10/24/2006
Last updated
02/23/2017
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