Provider Demographics
NPI:1609214147
Name:GONZALEZ ROEPKE, RAQUEL I (FNP-C, MSN)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:I
Last Name:GONZALEZ ROEPKE
Suffix:
Gender:F
Credentials:FNP-C, MSN
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-670-6923
Mailing Address - Fax:770-670-6927
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:770-670-6923
Practice Address - Fax:770-670-6927
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2015-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN200412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136160AMedicaid
GA202I506046Medicare PIN