Provider Demographics
NPI:1871844431
Name:SORACE, BREANNA LEIGH (CNP)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:SORACE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7668
Mailing Address - Country:US
Mailing Address - Phone:678-947-4000
Mailing Address - Fax:678-455-0010
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 210
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7668
Practice Address - Country:US
Practice Address - Phone:678-947-4000
Practice Address - Fax:678-455-0010
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily