Basic Information
| Provider Information | |||||||||
| NPI: | 1528505286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NESBITT | ||||||||
| FirstName: | AQUANETTA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 N MATTHEWS RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295607024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433748380 | ||||||||
| FaxNumber: | 8433745247 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 N MATTHEWS RD | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295607024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433748380 | ||||||||
| FaxNumber: | 8433745247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2017 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 21051 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 21051 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.