Provider Demographics
NPI:1306306428
Name:CUESTA, ANALVIS (MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:ANALVIS
Middle Name:
Last Name:CUESTA
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:770-942-0457
Mailing Address - Fax:770-942-7699
Practice Address - Street 1:4586 TIMBER RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7514
Practice Address - Country:US
Practice Address - Phone:786-443-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003228422BMedicaid
GAG18815AOtherMEDICARE PTAN
GA003228422AMedicaid