Provider Demographics
NPI:1003445313
Name:MISHRA, SARIKA (NP)
Entity Type:Individual
Prefix:
First Name:SARIKA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 WIND CHIME CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5481
Mailing Address - Country:US
Mailing Address - Phone:404-966-5543
Mailing Address - Fax:
Practice Address - Street 1:400 TOWER RD NE STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9412
Practice Address - Country:US
Practice Address - Phone:770-422-1372
Practice Address - Fax:770-999-2488
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2022-08-17
Deactivation Date:2020-10-07
Deactivation Code:
Reactivation Date:2020-10-16
Provider Licenses
StateLicense IDTaxonomies
GARN244634163W00000X, 363LA2100X
CA95158236163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency