Provider Demographics
NPI:1376083956
Name:MCCONNELL, DERICK (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WASHINGTON STREET NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-531-0998
Mailing Address - Fax:678-433-2059
Practice Address - Street 1:723 WASHINGTON ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-531-0998
Practice Address - Fax:678-433-2059
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily