MRS. CAROLINE BANTA DEROSA (NPI# 1841685831) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841685831 |
| Entity Type | Individual |
| Full Name | MRS. CAROLINE BANTA DEROSA |
| Credential | APRN |
| Practice Address |
600 Dot Barn Rd Bloomingdale GA 31302-9353 |
| Mailing Address |
66 Godley Park Way Pooler GA 31322-3974 |
| Practice Telephone | 9123308335 |
| Mailing Telephone | 6783721496 |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN245640 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
600 DOT BARN RD |
| City | BLOOMINGDALE |
| State | GA |
| Zip Code | 31302-9353 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598848277 | Lakeside Crisis Stabilization | Residential Treatment Facility, Emotionally Disturbed Children | 600 Dot Barn Rd, Bloomingdale, GA 31302-9353 | 2006-10-24 |
| 1518324128 | Lakeside Csu | Psychiatric Residential Treatment Facility | 600 Dot Barn Rd, Bloomingdale, GA 31302-9353 | 2016-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942772975 | Wee Care Pediatric Therapy, LLC | Physical Therapist | 335 Old Rail Rd, Bloomingdale, GA 31302-4025 | 2019-01-02 |
| 1427527837 | Steven Keith Gordon | Pharmacist | 3010 Us Highway 80 Ste B, Bloomingdale, GA 31302-4557 | 2018-11-14 |
| 1912551060 | Dinu Patel | Pharmacist | 3010 Us Highway 80 Ste B, Bloomingdale, GA 31302-4557 | 2019-07-27 |
| 1730448457 | Gordons Pharmacy LLC | Pharmacy | 3010 Us Highway 80, Unit B, Bloomingdale, GA 31302-4558 | 2012-05-15 |
| 1639788136 | Walker Health and Wellness LLC | Clinic/Center | 111 Bradford Dr, Bloomingdale, GA 31302-4926 | 2020-07-30 |
| 1952851602 | Gates Health Care Services, LLC | Assisted Living Facility | 400 Wallace Cir, Bloomingdale, GA 31302-8050 | 2016-10-06 |
| 1417238874 | Andrew J Beyrer | Social Worker | 639 John Carter Rd, Bloomingdale, GA 31302-8065 | 2011-08-30 |
| 1720556608 | Matthew Sartin | Behavioral Analyst | 639 John Carter Rd, Bloomingdale, GA 31302-8065 | 2018-11-08 |
| 1538567029 | Carliss Posey | Speech-Language Pathologist | 404 Gravel Way, Bloomingdale, GA 31302-8119 | 2014-12-15 |
| 1316559156 | Jennifer Anne Hillberry | Counselor | 311 Coconut Dr, Bloomingdale, GA 31302-8138 | 2020-08-22 |
| Find all providers in zip 31302 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609152842 | Allison A Sikorsky | Nurse Practitioner | 132 W Lake St, Bloomingdale, IL 60108-1020 | 2011-11-02 |
| 1740836980 | At Your Service Psychiatry, Pllc | Nurse Practitioner | 132 W Lake St, Bloomingdale, IL 60108-1020 | 2019-08-14 |
| 1134603046 | Nirmal Dass | Nurse Practitioner | 1 Tiffany Pt Ste 110, Bloomingdale, IL 60108-2915 | 2018-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740398 | Audline Maria Hodnett | Nurse Practitioner | 4805 W Village Way Se Apt 2208, Smyrna, GA 30080-9227 | 2020-11-05 |
| 1073111845 | George Mackel, Pmhnp-bc, LLC | Nurse Practitioner | 12034 Big Canoe, 400 Shetland Trace, Jasper, GA 30143 | 2020-10-14 |
| 1356958060 | Earl Delk | Nurse Practitioner | 3365 Ridgerock Way, Snellville, GA 30078-4176 | 2020-09-26 |
| 1609482991 | Tammy Haskins Bailey | Nurse Practitioner | 196 Laying Farm Rd Se, Milledgeville, GA 31061-9714 | 2020-09-22 |
| 1861007403 | Caring Clinic LLC | Nurse Practitioner | 114 Wrights Dr, Milledgeville, GA 31061 | 2020-09-10 |
| 1376156364 | Katrina Ransom Clark | Nurse Practitioner | 120 Walker Dr Nw, Milledgeville, GA 31061-9561 | 2020-08-28 |
| 1457963746 | Evelyn Ahiante Dennis | Nurse Practitioner | 3325 Emden Ct, Snellville, GA 30039-6047 | 2020-08-19 |
| 1194335620 | Jennifer Logan | Nurse Practitioner | 424 Scotts Way, Augusta, GA 30909-3135 | 2020-08-10 |
| 1750991592 | Jamie Rae Mccracken | Nurse Practitioner | 2538 Gordon Cir Se, Smyrna, GA 30080-8123 | 2020-08-06 |
| 1285244608 | Amcare Substance Abuse and Addiction Counseling | Nurse Practitioner | 3615 Hutchinson Rd Ste 203, Cumming, GA 30040-0501 | 2020-08-01 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMINGDALE |
| Zip Code | 31302 |
Please comment or provide details below to improve the information on MRS. CAROLINE BANTA DEROSA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.