Provider Demographics
NPI:1124696703
Name:BEZGINOVA, SEVILYA R (FNP)
Entity type:Individual
Prefix:
First Name:SEVILYA
Middle Name:R
Last Name:BEZGINOVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CARRIAGE STATION CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4654
Mailing Address - Country:US
Mailing Address - Phone:404-647-3437
Mailing Address - Fax:
Practice Address - Street 1:125 CARRIAGE STATION CIR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4654
Practice Address - Country:US
Practice Address - Phone:404-647-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251545363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care