Provider Demographics
NPI:1770024820
Name:PATEL, ROSANI (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROSANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 MONHEGAN WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6364
Mailing Address - Country:US
Mailing Address - Phone:770-337-7123
Mailing Address - Fax:
Practice Address - Street 1:1401 DRESDEN DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3579
Practice Address - Country:US
Practice Address - Phone:404-814-9808
Practice Address - Fax:404-814-6086
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily