Provider Demographics
NPI:1467510644
Name:TUDORANCEA, DEANNA L (NP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:TUDORANCEA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 COTTON INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4457
Mailing Address - Country:US
Mailing Address - Phone:770-517-4802
Mailing Address - Fax:
Practice Address - Street 1:185 COTTON INDIAN CREEK RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-4457
Practice Address - Country:US
Practice Address - Phone:770-320-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner