Provider Demographics
NPI:1508412453
Name:CUCUTA, EUGENIU BORIS (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EUGENIU
Middle Name:BORIS
Last Name:CUCUTA
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:GENE
Other - Middle Name:B
Other - Last Name:CUCUTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3260 PEBBLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7232
Mailing Address - Country:US
Mailing Address - Phone:678-777-2731
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD ALABAMA RD STE 128A
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-1901
Practice Address - Country:US
Practice Address - Phone:770-821-1940
Practice Address - Fax:770-821-1950
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN265642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily