Provider Demographics
NPI:1447016795
Name:PARK, ANNY (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANNY
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 RIVER GREEN PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8333
Mailing Address - Country:US
Mailing Address - Phone:678-417-0077
Mailing Address - Fax:678-417-0337
Practice Address - Street 1:4855 RIVER GREEN PKWY STE 140
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8333
Practice Address - Country:US
Practice Address - Phone:678-417-0077
Practice Address - Fax:678-417-0337
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily