Provider Demographics
NPI:1316248115
Name:LANDRY, ANTRINA DENISE BRANTLEY (RN, MSN, PNP-AC)
Entity type:Individual
Prefix:MRS
First Name:ANTRINA
Middle Name:DENISE BRANTLEY
Last Name:LANDRY
Suffix:
Gender:F
Credentials:RN, MSN, PNP-AC
Other - Prefix:
Other - First Name:ANTRINA
Other - Middle Name:DENISE
Other - Last Name:BRANTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, PNP-AC
Mailing Address - Street 1:1001 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1605
Mailing Address - Country:US
Mailing Address - Phone:404-785-2008
Mailing Address - Fax:
Practice Address - Street 1:1001 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19994363L00000X
GA288454363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner