Provider Demographics
NPI:1629401831
Name:GOLAN, TALI (FNP)
Entity Type:Individual
Prefix:
First Name:TALI
Middle Name:
Last Name:GOLAN
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 1:2400 PARKLAND DR NE
Mailing Address - Street 2:UNIT 485
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3589
Mailing Address - Country:US
Mailing Address - Phone:646-548-5718
Mailing Address - Fax:
Practice Address - Street 1:2400 PARKLAND DR NE
Practice Address - Street 2:UNIT 485
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3589
Practice Address - Country:US
Practice Address - Phone:646-548-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily