Provider Demographics
NPI:1215571971
Name:CONNOLLEY, MARISSA DANIELLE (FNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:DANIELLE
Last Name:CONNOLLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:DANIELLE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 8TH ST NW APT 520
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4563
Mailing Address - Country:US
Mailing Address - Phone:678-989-9252
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner