Provider Demographics
NPI:1467963942
Name:VATE, INA (NP)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:
Last Name:VATE
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 1:3255 TIG KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-9139
Mailing Address - Country:US
Mailing Address - Phone:678-982-9343
Mailing Address - Fax:
Practice Address - Street 1:3255 TIG KNIGHT RD.,
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3005
Practice Address - Country:US
Practice Address - Phone:678-982-9343
Practice Address - Fax:678-982-9343
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily