Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 25216 | TN |
N | 363LA2100X | Nurse Practitioner - Acute Care | 25216 | TN |
NPI | 1013489269 |
---|---|
Provider Name | Andrea Davis |
First Address | Hermitage, TN 37076-0900 |
Second Address | Nashville, TN 37203-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2018 |
Last Update Date | 24/01/2019 |