Provider Demographics
NPI:1366061566
Name:VARGAS, PAULA (RN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 LUCAS LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2070
Mailing Address - Country:US
Mailing Address - Phone:321-945-6577
Mailing Address - Fax:
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1717
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:404-425-1079
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9500678163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management