Gloria J Carusi, APRN, NP-C
Individual provider Active NPI Nurse Practitioner · Tyrone, GA
NPI 1497974414 · NPPES record last updated Jul 6, 2011
Key facts
- NPI
- 1497974414
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN044369 NP (GA)
- Practice address
- 110 Lloyd Ave
Tyrone, GA 30290-2124 - Phone
- (770) 486-1200
- Fax
- (770) 486-3697
- NPI assigned
- Apr 25, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN044369 NP | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta Primary Care Peachtree, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN044369 NP | GA | Yes |
Addresses
Primary practice location
110 Lloyd Ave
Tyrone, GA 30290-2124
Mailing address
110 Lloyd Ave
Tyrone, GA 30290-2124
Phone (770) 486-1200
Other providers in Tyrone, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.