Individual
TA-TANISHA PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
417 W 3RD AVE, ALBANY, GA 31701-1943
(229) 312-1000
Mailing address
500 W 3RD AVE STE 101, ALBANY, GA 31701-1900
(229) 312-5800
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2019015776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN168517
LICENSE
GA
Enumeration date
08/11/2020
Last updated
08/11/2020
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