Provider Demographics
NPI:1285199794
Name:TORRES, MARISSA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE STE 610
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4212
Mailing Address - Country:US
Mailing Address - Phone:404-653-0039
Mailing Address - Fax:404-653-0159
Practice Address - Street 1:285 BOULEVARD NE STE 610
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4212
Practice Address - Country:US
Practice Address - Phone:404-653-0039
Practice Address - Fax:404-653-0159
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1407869407OtherPRACTICE NPI
GARN236590OtherNURSE PRACTITIONER LICENSE
GAMT5205655OtherDEA
GA1285199794OtherNPI