Provider Demographics
NPI:1205935442
Name:NOTO, PENNY F (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:F
Last Name:NOTO
Suffix:
Gender:F
Credentials:DNP, 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 1:1120 15TH ST
Mailing Address - Street 2:EC-4336
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-2485
Mailing Address - Fax:706-721-8893
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:EC-4336
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-2485
Practice Address - Fax:706-721-8893
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN120275363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0646Medicaid
GA000974465AMedicaid
SCNP0646Medicaid
SCNP0646Medicaid