Provider Demographics
NPI:1083389977
Name:CANTRELL, ROBIN (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 GRIFFIN CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1462
Mailing Address - Country:US
Mailing Address - Phone:662-397-4170
Mailing Address - Fax:
Practice Address - Street 1:553 GRIFFIN CIR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1462
Practice Address - Country:US
Practice Address - Phone:662-397-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30194363L00000X
TN212219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse