Provider Demographics
NPI:1942591482
Name:MARUCCO, KATHRYN WINN (PNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WINN
Last Name:MARUCCO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1497 FAIR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0822
Mailing Address - Country:US
Mailing Address - Phone:912-871-4847
Mailing Address - Fax:912-871-5562
Practice Address - Street 1:1497 FAIR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0822
Practice Address - Country:US
Practice Address - Phone:912-871-4847
Practice Address - Fax:912-871-5562
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN216845363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics