Provider Demographics
NPI:1083617641
Name:PROSSER, RINA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:MARIE
Last Name:PROSSER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BREWER ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4027
Mailing Address - Country:US
Mailing Address - Phone:731-415-3574
Mailing Address - Fax:731-240-0232
Practice Address - Street 1:201 N BREWER ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4027
Practice Address - Country:US
Practice Address - Phone:731-415-3574
Practice Address - Fax:731-240-0232
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7205367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026850Medicaid
TNQ001330Medicaid
TNAPN7205OtherADVANCED PRACTICE NURSE
TN3903155Medicare Oscar/Certification
TN13000OtherANCC
TNRN105806OtherREGISTERED NURSE
TN3719301Medicare PIN
TN900231747OtherPALMETO GBA
TNP57471Medicare UPIN
TN3903155Medicaid
1500179OtherAMCB CERTIFICATION NUMBER