Provider Demographics
NPI:1093376162
Name:SWANNER, TINA LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:SWANNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CLARKSTON DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4151
Mailing Address - Country:US
Mailing Address - Phone:850-603-0603
Mailing Address - Fax:
Practice Address - Street 1:7003 CHADWICK DR STE 350
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3260
Practice Address - Country:US
Practice Address - Phone:615-866-9623
Practice Address - Fax:615-827-0124
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily