Provider Demographics
NPI:1497974414
Name:CARUSI, GLORIA J (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:CARUSI
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2124
Mailing Address - Country:US
Mailing Address - Phone:770-486-1200
Mailing Address - Fax:770-486-3697
Practice Address - Street 1:110 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2124
Practice Address - Country:US
Practice Address - Phone:770-486-1200
Practice Address - Fax:770-486-3697
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044369 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner