Provider Demographics
NPI:1285370460
Name:FABREGA, ELAINE CLAIRE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CLAIRE
Last Name:FABREGA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 PRINCESS LN SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6715
Mailing Address - Country:US
Mailing Address - Phone:678-343-5401
Mailing Address - Fax:
Practice Address - Street 1:2419 PRINCESS LN SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6715
Practice Address - Country:US
Practice Address - Phone:678-343-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN298056363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics