1215385992 NPI number — MRS. DIONNE TEHSHEEN BRAVO FNP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215385992 NPI number — MRS. DIONNE TEHSHEEN BRAVO FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAVO
Provider First Name:
DIONNE
Provider Middle Name:
TEHSHEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARCLAY
Provider Other First Name:
DIONNE
Provider Other Middle Name:
TEHSHEEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215385992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4910 JONESBORO RD
Provider Second Line Business Mailing Address:
BLDG 700, SUITE 1
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30291-2085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-964-7736
Provider Business Mailing Address Fax Number:
770-306-1726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4910 JONESBORO RD
Provider Second Line Business Practice Location Address:
BLDG 700, SUITE 1
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30291-2085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-964-7736
Provider Business Practice Location Address Fax Number:
770-306-1726
Provider Enumeration Date:
06/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  182045 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN182045 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com