Provider Demographics
NPI:1558534768
Name:DEESE, GEOVANNA (FNP)
Entity Type:Individual
Prefix:
First Name:GEOVANNA
Middle Name:
Last Name:DEESE
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5641 POPLAR TENT RD
Practice Address - Street 2:STE 101
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7533
Practice Address - Country:US
Practice Address - Phone:704-782-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003955363L00000X
NC156671363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004583Medicaid
NC1558534768Medicaid
SCNP3626Medicaid
NC2593225MMedicare PIN
NC2593225AMedicare PIN
NC7004583Medicaid
NC2593225CMedicare PIN
NC2593225FMedicare PIN
NC2593225HMedicare PIN
NC2593225PMedicare PIN
NCNC0099AMedicare PIN
NC1558534768Medicaid
NC2593225DMedicare PIN
NC2593225EMedicare PIN
NC2593225GMedicare PIN
NC2593225Medicare PIN
SCNP3626Medicaid
NC2593225KMedicare PIN
NC2593225NMedicare PIN
NC2593225BMedicare PIN