Provider Demographics
NPI:1386144400
Name:TRAWICK, TARRA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TARRA
Middle Name:MARIE
Last Name:TRAWICK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TARRA
Other - Middle Name:MARIE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5835 CAMPBELLTON RD SW STE 105
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8014
Mailing Address - Country:US
Mailing Address - Phone:678-705-4900
Mailing Address - Fax:
Practice Address - Street 1:5835 CAMPBELLTON RD SW STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8014
Practice Address - Country:US
Practice Address - Phone:678-705-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily