Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 225335 | TN |
NPI | 1053881045 |
---|---|
Provider Name | Caitlin Decamillis Copeland |
First Address | Nashville, TN 37209-4821 |
Second Address | Nashville, TN 37232-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2018 |
Last Update Date | 29/09/2021 |