Provider Demographics
NPI:1750964680
Name:MANDIBAYA, PLAXEDES T (APRN-FNP-BC)
Entity type:Individual
Prefix:
First Name:PLAXEDES
Middle Name:T
Last Name:MANDIBAYA
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1779
Mailing Address - Country:US
Mailing Address - Phone:404-748-3425
Mailing Address - Fax:
Practice Address - Street 1:3449 ALLIE DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-7105
Practice Address - Country:US
Practice Address - Phone:404-748-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner