Provider Demographics
NPI:1114303773
Name:DRAKE, GRETCHEN (APN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HAYES ST STE 800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2659
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:
Practice Address - Street 1:250 25TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-320-5090
Practice Address - Fax:615-320-1617
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN183960163W00000X
TN20558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018164Medicaid
10350I1812Medicare PIN
10350I7157Medicare PIN