Provider Demographics
NPI:1457968307
Name:PARILLO, TRACI JO (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:JO
Last Name:PARILLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PAGE PLACE ROAD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9050
Mailing Address - Country:US
Mailing Address - Phone:912-259-9619
Mailing Address - Fax:912-259-9618
Practice Address - Street 1:421 PAGE PLACE ROAD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-9050
Practice Address - Country:US
Practice Address - Phone:912-259-9619
Practice Address - Fax:912-259-9618
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily