Provider Demographics
NPI:1043413123
Name:FANFAN, CARLINE ALVARES
Entity Type:Individual
Prefix:MRS
First Name:CARLINE
Middle Name:ALVARES
Last Name:FANFAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LINCOLN LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-7216
Mailing Address - Country:US
Mailing Address - Phone:615-862-7940
Mailing Address - Fax:615-880-2194
Practice Address - Street 1:224 ORIEL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4910
Practice Address - Country:US
Practice Address - Phone:615-862-7297
Practice Address - Fax:615-880-2194
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000105065163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health