Individual provider Active NPI

Cathy Dee Giomblanco, ARNP

  • Primary Care Nurse Practitioner
  • Buford, GA
National Provider Identifier
1427678259
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
110411 Issued in WV
Practice address
3703 Southland Dr
Buford, GA 30519-7096
Phone
(954) 393-4219
NPI assigned
Apr 22, 2020
Last updated
Sep 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11006894 FL
Primary Care Nurse Practitioner 363LP2300X 294046 GA
Primary Care Nurse Practitioner 363LP2300X 110411 WV Primary

Addresses

Primary practice location

3703 Southland Dr
Buford, GA 30519-7096

Mailing address

3703 Southland Dr
Buford, GA 30519-7096
Phone (954) 393-4219

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, WV2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220630000719 GA Practitioner - Nurse Practitioner 9234540394 Reassigns benefits to 1 organization
I20230112000840 WV Practitioner - Nurse Practitioner 9234540394 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11006894FLMDFamily Nurse Practitioner
294046GAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
E Success Health LLC Family Current Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1427678259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3703 SOUTHLAND DR",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305197096",
            "telephone_number": "954-393-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3703 SOUTHLAND DR",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305197096",
            "telephone_number": "954-393-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIOMBLANCO",
        "first_name": "CATHY",
        "middle_name": "DEE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-22",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11006894",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "294046",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WV",
            "license": "110411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

Verify at the official NPI Registry.