Provider Demographics
NPI:1639583396
Name:HOMA, GINA RENE (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:RENE
Last Name:HOMA
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HABERSHAM LANDING DR
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4827
Mailing Address - Country:US
Mailing Address - Phone:706-768-0771
Mailing Address - Fax:
Practice Address - Street 1:135 HABERSHAM LANDING DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4827
Practice Address - Country:US
Practice Address - Phone:706-768-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily