Provider Demographics
NPI:1043529829
Name:BORKOVICH, EILEEN (APRN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BORKOVICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 HOLCOMB BRIDGE RD STE 129
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2126
Mailing Address - Country:US
Mailing Address - Phone:678-325-2250
Mailing Address - Fax:678-325-2261
Practice Address - Street 1:1475 HOLCOMB BRIDGE RD STE 129
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2126
Practice Address - Country:US
Practice Address - Phone:678-325-2250
Practice Address - Fax:678-325-2261
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily