Provider Demographics
NPI:1851081657
Name:SPAVENTA, ANTONIO V JR (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:V
Last Name:SPAVENTA
Suffix:JR
Gender:M
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 1:6005 WATSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6542
Mailing Address - Country:US
Mailing Address - Phone:478-956-5002
Mailing Address - Fax:478-956-5003
Practice Address - Street 1:6005 WATSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6542
Practice Address - Country:US
Practice Address - Phone:478-956-5002
Practice Address - Fax:478-956-5003
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily