Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 20598 | TN |
NPI | 1013386929 |
---|---|
Provider Name | Justin Groce |
First Address | Lebanon, TN 37087-1340 |
Second Address | Lebanon, TN 37087-1340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3306523 | UNITED HEALTHCARE (01) | TN |
6060213 | BCBS OF TN (01) | TN |
620842749 | HUMANA (01) | TN |
P01697499 | R/R MEDICARE (01) | TN |
Q021233 | (05) | TN |