Provider Demographics
NPI:1124488259
Name:DITTA-DONAHUE, GINA (CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DITTA-DONAHUE
Suffix:
Gender:F
Credentials:CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 TENCH RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6741
Mailing Address - Country:US
Mailing Address - Phone:470-266-1380
Mailing Address - Fax:470-477-1809
Practice Address - Street 1:4485 TENCH RD STE 1120
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6741
Practice Address - Country:US
Practice Address - Phone:470-266-1380
Practice Address - Fax:470-447-1809
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285530363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily