Provider Demographics
NPI:1376304741
Name:MINOTT, PAMELA A (CNA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:MINOTT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 MCGAULEY RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4410
Mailing Address - Country:US
Mailing Address - Phone:407-782-0223
Mailing Address - Fax:
Practice Address - Street 1:5238 MCGAULEY RD
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-4410
Practice Address - Country:US
Practice Address - Phone:407-782-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014221853376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide