Provider Demographics
NPI: | 1003411885 |
---|---|
Name: | PATRICK, AUNDREA NICOLE (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | AUNDREA |
Middle Name: | NICOLE |
Last Name: | PATRICK |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | AUNDREA |
Other - Middle Name: | NICOLE |
Other - Last Name: | IPOX |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | RN |
Mailing Address - Street 1: | 1326 PAPERMILL POINTE WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | KNOXVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37909-1903 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 865-673-5000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1342 PAPERMILL POINTE WAY |
Practice Address - Street 2: | |
Practice Address - City: | KNOXVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37909-1903 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-288-8947 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2020-12-01 |
Last Update Date: | 2022-11-10 |
Deactivation Date: | 2022-10-17 |
Deactivation Code: | |
Reactivation Date: | 2022-10-26 |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 226561 | 163W00000X |
TN | 32819 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
1003411885 | Other | NPI |