Provider Demographics
NPI:1376972539
Name:BUKSHTEYN, IRINA (FNP-C)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BUKSHTEYN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 BARDFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7334
Mailing Address - Country:US
Mailing Address - Phone:770-309-9990
Mailing Address - Fax:
Practice Address - Street 1:401 S MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1958
Practice Address - Country:US
Practice Address - Phone:404-836-9906
Practice Address - Fax:470-545-4768
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily