Provider Demographics
NPI:1316578578
Name:MAIAVA, BENTLEY ELIZABETH KNOX (PNP)
Entity type:Individual
Prefix:
First Name:BENTLEY
Middle Name:ELIZABETH KNOX
Last Name:MAIAVA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2210 HOLLY SPRINGS PKWY UNIT 1305
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30142-1760
Mailing Address - Country:US
Mailing Address - Phone:770-990-7382
Mailing Address - Fax:
Practice Address - Street 1:1205 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4878
Practice Address - Country:US
Practice Address - Phone:229-759-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN249087363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics