Provider Demographics
NPI:1588181853
Name:SPENCER, VINCENT (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5563 ROSE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5078
Mailing Address - Country:US
Mailing Address - Phone:678-231-0309
Mailing Address - Fax:
Practice Address - Street 1:3621 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3419
Practice Address - Country:US
Practice Address - Phone:770-910-9196
Practice Address - Fax:770-910-9197
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily