Provider Demographics
NPI:1942894183
Name:PENNINO, MEREDITH (APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:PENNINO
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12460 CRABAPPLE RD # 202-277
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6602
Mailing Address - Country:US
Mailing Address - Phone:727-688-3138
Mailing Address - Fax:
Practice Address - Street 1:3020 MERCER UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4145
Practice Address - Country:US
Practice Address - Phone:770-458-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011883363LP0200X
GARN302421363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics