Provider Demographics
NPI:1053685362
Name:JAYCOX, LISA ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:JAYCOX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKE BROOK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3761
Mailing Address - Country:US
Mailing Address - Phone:865-374-0600
Mailing Address - Fax:
Practice Address - Street 1:3001 LAKE BROOK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3761
Practice Address - Country:US
Practice Address - Phone:865-374-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9208812163W00000X
FLARNP9208812363L00000X
TN31303363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020717700Medicaid
FLTGWF7OtherBCBS
FLIY900ZOtherMEDICARE