Provider Demographics
NPI:1982002317
Name:PALMER, ALEXANDRA FUTCH (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:FUTCH
Last Name:PALMER
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ALEXANDRA
Other - Last Name:FUTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3878 WHITTINGTON DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4204
Mailing Address - Country:US
Mailing Address - Phone:352-208-2128
Mailing Address - Fax:
Practice Address - Street 1:3878 WHITTINGTON DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4204
Practice Address - Country:US
Practice Address - Phone:352-208-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily