Provider Demographics
NPI:1225222524
Name:VAZ, DENISE S (C-PNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:S
Last Name:VAZ
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2304
Mailing Address - Country:US
Mailing Address - Phone:770-886-5437
Mailing Address - Fax:770-886-9717
Practice Address - Street 1:204 CANTON RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2304
Practice Address - Country:US
Practice Address - Phone:770-886-5437
Practice Address - Fax:770-886-9717
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172992NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics