Provider Demographics
NPI:1215385992
Name:BRAVO, DIONNE TEHSHEEN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DIONNE
Middle Name:TEHSHEEN
Last Name:BRAVO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:DIONNE
Other - Middle Name:TEHSHEEN
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4910 JONESBORO RD
Mailing Address - Street 2:BLDG 700, SUITE 1
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2085
Mailing Address - Country:US
Mailing Address - Phone:770-964-7736
Mailing Address - Fax:770-306-1726
Practice Address - Street 1:4910 JONESBORO RD
Practice Address - Street 2:BLDG 700, SUITE 1
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2085
Practice Address - Country:US
Practice Address - Phone:770-964-7736
Practice Address - Fax:770-306-1726
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA182045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily