Basic Information
| Provider Information | |||||||||
| NPI: | 1043676380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOZILE | ||||||||
| FirstName: | PETRA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | NOZILE | ||||||||
| OtherFirstName: | PETRA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | FNP-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1058 BEAR CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302281849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707070808 | ||||||||
| FaxNumber: | 7707071580 | ||||||||
| Practice Location | |||||||||
| Address1: | 1058 BEAR CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302281849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707070808 | ||||||||
| FaxNumber: | 7707071580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2015 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN174065 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.