Individual
JESSICA CAROLINE MIMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, FNP-C
Contact information
Practice address
6120 HICKORY FLAT HWY, CANTON, GA 30115
(866) 389-2727
(401) 652-9787
Mailing address
6120 HICKORY FLAT HWY, CANTON, GA 30115
(407) 247-6442
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN239259
GA
363LA2200X
Adult Health Nurse Practitioner
RN239259
GA
363LF0000X
Family Nurse Practitioner
Primary
RN239259
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN239259
GA NP LICENSE
GA
Enumeration date
08/24/2016
Last updated
02/04/2021
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