Provider Demographics
NPI:1992589691
Name:GARRAUD, ELDINE (FNP)
Entity type:Individual
Prefix:
First Name:ELDINE
Middle Name:
Last Name:GARRAUD
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 1:3067 ELMENDORF LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7426
Mailing Address - Country:US
Mailing Address - Phone:561-255-3144
Mailing Address - Fax:
Practice Address - Street 1:3067 ELMENDORF LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7426
Practice Address - Country:US
Practice Address - Phone:561-255-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner