Provider Demographics
NPI:1477259737
Name:LAVENDER, CEDRICKA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CEDRICKA
Middle Name:
Last Name:LAVENDER
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 1:2075 HAMILTON CREEK PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7285
Mailing Address - Country:US
Mailing Address - Phone:770-586-0300
Mailing Address - Fax:
Practice Address - Street 1:2075 HAMILTON CREEK PKWY UNIT 200
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7285
Practice Address - Country:US
Practice Address - Phone:770-586-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily