Provider Demographics
NPI:1063451607
Name:SMITH, PATRICIA DIANE (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DIANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 25TH AVE. SOUTH
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212
Mailing Address - Country:US
Mailing Address - Phone:615-873-8170
Mailing Address - Fax:615-873-8174
Practice Address - Street 1:1310 25TH AVE. S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-873-8170
Practice Address - Fax:615-873-8174
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006987363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648710Medicaid
TNQ41754Medicare UPIN
TN3648710Medicaid