Provider Demographics
NPI:1437134483
Name:AHEARN, NANCI BRINN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCI
Middle Name:BRINN
Last Name:AHEARN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 INTERCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7661
Mailing Address - Country:US
Mailing Address - Phone:912-527-5301
Mailing Address - Fax:912-756-4740
Practice Address - Street 1:89 INTERCHANGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7661
Practice Address - Country:US
Practice Address - Phone:912-527-5301
Practice Address - Fax:912-756-4740
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH36527Medicare UPIN
GA202I504967Medicare PIN
NCBH7344031OtherDEA
NCH36527Medicare UPIN