Provider Demographics
NPI:1427678259
Name:GIOMBLANCO, CATHY DEE (ARNP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:DEE
Last Name:GIOMBLANCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7096
Mailing Address - Country:US
Mailing Address - Phone:954-393-4219
Mailing Address - Fax:
Practice Address - Street 1:3703 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7096
Practice Address - Country:US
Practice Address - Phone:954-393-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006894363LF0000X
GA294046363LP2300X
WV110411363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily