Provider Demographics
NPI:1124465588
Name:POPE, BIANCA RAE (FNP)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:RAE
Last Name:POPE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:RAE
Other - Last Name:GERMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3212 SHRINE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4353
Mailing Address - Country:US
Mailing Address - Phone:912-289-7004
Mailing Address - Fax:912-289-7004
Practice Address - Street 1:3212 SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4353
Practice Address - Country:US
Practice Address - Phone:912-289-7004
Practice Address - Fax:912-289-7004
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203157207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty