Provider Demographics
NPI:1740612985
Name:MARESCA, AMY CARMICHAEL (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CARMICHAEL
Last Name:MARESCA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2792 SMITHSONIA WAY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2617
Mailing Address - Country:US
Mailing Address - Phone:770-312-3562
Mailing Address - Fax:
Practice Address - Street 1:4356 COMMUNICATIONS DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2901
Practice Address - Country:US
Practice Address - Phone:770-312-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily