Provider Demographics
NPI:1043633084
Name:PARK, NANYOUNG (ANP-BC)
Entity type:Individual
Prefix:
First Name:NANYOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4817
Mailing Address - Country:US
Mailing Address - Phone:770-614-9799
Mailing Address - Fax:770-614-9789
Practice Address - Street 1:3590 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4817
Practice Address - Country:US
Practice Address - Phone:770-614-9799
Practice Address - Fax:770-614-9789
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN190483364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health