Provider Demographics
NPI:1225627227
Name:THOMAS-RENTZ, AYANNA
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:THOMAS-RENTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYANNA
Other - Middle Name:
Other - Last Name:RENTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:915 W PEACHTREE ST NW UNIT 515
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4621
Mailing Address - Country:US
Mailing Address - Phone:727-254-2614
Mailing Address - Fax:
Practice Address - Street 1:1280 HIGHWAY 74 S STE E
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3077
Practice Address - Country:US
Practice Address - Phone:678-961-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114033363A00000X
GA10571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant