Provider Demographics
NPI:1366119364
Name:BERGQUIST, AMY (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BERGQUIST
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 SANDHILL HICKORY LVL RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-8158
Mailing Address - Country:US
Mailing Address - Phone:404-784-2675
Mailing Address - Fax:
Practice Address - Street 1:706 DIXIE ST STE 320
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3890
Practice Address - Country:US
Practice Address - Phone:770-812-9326
Practice Address - Fax:770-836-9358
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN-NP230576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily