Provider Demographics
NPI:1376892802
Name:RABORN, NANCY (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:RABORN
Suffix:
Gender:F
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 1:1065 LULLWATER CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-836-3338
Practice Address - Street 1:125 EAGLE SPRING DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6328
Practice Address - Country:US
Practice Address - Phone:770-213-3366
Practice Address - Fax:855-516-2317
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA136892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily