Provider Demographics
NPI:1578892071
Name:PROVINS, CATHLEEN ANN (RN, ACNP-BC, PHD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANN
Last Name:PROVINS
Suffix:
Gender:F
Credentials:RN, ACNP-BC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE STREET -DAVIS FISCHER BUILDING OFFICE 324
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-686-1000
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE BLDG 324
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-686-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN098946363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care