Provider Demographics
NPI:1790264703
Name:BIZARROQUE, ALISON DIANE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:DIANE
Last Name:BIZARROQUE
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 1:436 ENGLE DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2015
Mailing Address - Country:US
Mailing Address - Phone:678-887-8295
Mailing Address - Fax:
Practice Address - Street 1:436 ENGLE DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2015
Practice Address - Country:US
Practice Address - Phone:678-887-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily