Provider Demographics
NPI:1518678994
Name:BUCARIZA, NOELLE ANN (NP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANN
Last Name:BUCARIZA
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 1:203 E 4TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3272
Mailing Address - Country:US
Mailing Address - Phone:478-228-6407
Mailing Address - Fax:
Practice Address - Street 1:1165 SANDERS RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5965
Practice Address - Country:US
Practice Address - Phone:470-533-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271215363LF0000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency