Provider Demographics
NPI:1033176532
Name:IRVIN, JOANNE D (FNP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:D
Last Name:IRVIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LEE
Other - Last Name:DIFFLEY-CANNIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:ATTN WANDA BROWN CREDENTIALING
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-272-9163
Mailing Address - Fax:423-921-6920
Practice Address - Street 1:4966 HIGHWAY 11W
Practice Address - Street 2:HAWKINS MEDICAL CENTER
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857
Practice Address - Country:US
Practice Address - Phone:423-272-5600
Practice Address - Fax:423-272-1428
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3643282Medicaid
TN4124843OtherBCBST
TN4124843OtherBCBST
TN3643282Medicaid
36432821Medicare PIN
3703865Medicare PIN