Provider Demographics
NPI:1962147744
Name:NANNA, ELOHO OBATARE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELOHO
Middle Name:OBATARE
Last Name:NANNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 COBBLEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7903
Mailing Address - Country:US
Mailing Address - Phone:404-514-4765
Mailing Address - Fax:
Practice Address - Street 1:2011 COBBLEFIELD CIR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7903
Practice Address - Country:US
Practice Address - Phone:404-514-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA216684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily