Provider Demographics
NPI:1669038303
Name:JOSEPH, MONIQUE ANTOINETTE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:ANTOINETTE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:ANTOINETTE
Other - Last Name:PAULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:3012 NORWELL CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3450
Mailing Address - Country:US
Mailing Address - Phone:404-245-5516
Mailing Address - Fax:
Practice Address - Street 1:3334 HIGHWAY 155 STE B
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248
Practice Address - Country:US
Practice Address - Phone:770-305-7929
Practice Address - Fax:770-305-7969
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170750363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner