Provider Demographics
NPI:1699304881
Name:OCTAVIEN, LINDA (FNP-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:OCTAVIEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 NATURAL BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2614
Mailing Address - Country:US
Mailing Address - Phone:678-387-8719
Mailing Address - Fax:
Practice Address - Street 1:2250 SATELLITE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4917
Practice Address - Country:US
Practice Address - Phone:470-981-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2024-07-15
Deactivation Date:2024-06-19
Deactivation Code:
Reactivation Date:2024-07-09
Provider Licenses
StateLicense IDTaxonomies
GARN172559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily