Provider Demographics
NPI:1689052656
Name:FORCHIN, JEUNESE (FNP)
Entity Type:Individual
Prefix:
First Name:JEUNESE
Middle Name:
Last Name:FORCHIN
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 1:1411 PINELLA CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1185
Mailing Address - Country:US
Mailing Address - Phone:847-942-5779
Mailing Address - Fax:
Practice Address - Street 1:3180 N POINT PKWY STE 302
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4381
Practice Address - Country:US
Practice Address - Phone:404-800-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272161363LF0000X
IL209012427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily