FANISKA MASSILLON

NORCROSS, GA
NPI1093338733
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: NY  F346372-01)
Additional Taxonomies363LF0000X Nurse Practitioner, Family
(Licence: CA  95030305)
363LF0000X Nurse Practitioner, Family
(Licence: FL  APRN11006594)
Enumeration Date2020-05-27
Last Update Date2025-01-26
Business Address
FANISKA MASSILLON
PO BOX 920095
NORCROSS, GA 30010-0095
Phone number: 407-308-9573
Mailing Address
FANISKA MASSILLON
PO BOX 920095
NORCROSS, GA 30010-0095
Phone number: 407-308-9573