Provider Demographics
NPI:1922590959
Name:COBUCCI, TESSA BUTLER (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:BUTLER
Last Name:COBUCCI
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 SPRINGFOUNT TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2161
Mailing Address - Country:US
Mailing Address - Phone:678-938-3525
Mailing Address - Fax:
Practice Address - Street 1:11660 ALPHARETTA HWY STE 290
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4963
Practice Address - Country:US
Practice Address - Phone:404-446-3900
Practice Address - Fax:404-446-3906
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207289363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1023045663Other08BCBFD