Provider Demographics
NPI:1760996342
Name:LOYD, DARQUITA MARANDO
Entity Type:Individual
Prefix:
First Name:DARQUITA
Middle Name:MARANDO
Last Name:LOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARQUITA
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:682 HEMLOCK ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8314
Mailing Address - Country:US
Mailing Address - Phone:478-633-4786
Mailing Address - Fax:
Practice Address - Street 1:682 HEMLOCK ST STE 210
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8314
Practice Address - Country:US
Practice Address - Phone:478-633-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner