Provider Demographics
NPI:1205072808
Name:DERR, GERLANDA (APRN)
Entity type:Individual
Prefix:
First Name:GERLANDA
Middle Name:
Last Name:DERR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GERLANDA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3715
Mailing Address - Country:US
Mailing Address - Phone:864-442-4110
Mailing Address - Fax:864-442-4126
Practice Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3715
Practice Address - Country:US
Practice Address - Phone:644-424-1108
Practice Address - Fax:864-442-4126
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00178800363LA2200X
SC21927363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty