Provider Demographics
NPI:1104250950
Name:TELEMAQUE, COYETTE ANNISEE (NP-C)
Entity type:Individual
Prefix:
First Name:COYETTE
Middle Name:ANNISEE
Last Name:TELEMAQUE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 HAMILTON MILL RD STE 1102
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:678-541-0588
Mailing Address - Fax:678-541-0610
Practice Address - Street 1:3331 HAMILTON MILL RD STE 1102
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:678-541-0588
Practice Address - Fax:678-541-0610
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily