Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 22199 | TN |
NPI | 1023555828 |
---|---|
Provider Name | Ms. Erin Elizabeth Fagot |
First Address | Goodlettsville, TN 37072-3132 |
Second Address | Nashville, TN 37203-1835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2017 |
Last Update Date | 17/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I500498 | MEDICARE (01) | TN |
6094166 | BCBS (01) | TN |
Q026872 | (05) | TN |