Provider Demographics
NPI:1598709255
Name:IANNAZZONE, SHIRLEY ANGELA (CPNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANGELA
Last Name:IANNAZZONE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:IANNAZZONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:1001 JOHNSON FERRY RD
Mailing Address - Street 2:SCOTTISH RITE DEPT OF ANES
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-785-2008
Mailing Address - Fax:404-785-4496
Practice Address - Street 1:1001 JOHNSON FERRY RD
Practice Address - Street 2:SCOTTISH RITE DEPT OF ANES
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-785-2008
Practice Address - Fax:404-785-4496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN054960NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics