Provider Demographics
NPI:1538496286
Name:ROLLINS, ANQUANA LAKERRAS (CNA)
Entity Type:Individual
Prefix:MS
First Name:ANQUANA
Middle Name:LAKERRAS
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 TUSSAHAW XING
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8638
Mailing Address - Country:US
Mailing Address - Phone:404-917-6672
Mailing Address - Fax:
Practice Address - Street 1:2055 TUSSAHAW XING
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8638
Practice Address - Country:US
Practice Address - Phone:404-917-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028889652376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide