Provider Demographics
NPI:1871124875
Name:CLEMONS, ADRIENNE NICOLE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 LANDING PT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9066
Mailing Address - Country:US
Mailing Address - Phone:786-327-8633
Mailing Address - Fax:
Practice Address - Street 1:1019 LANDING PT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9066
Practice Address - Country:US
Practice Address - Phone:786-327-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233484163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse