Provider Demographics
NPI:1114528049
Name:TENNESSEE TELEDERM PLLC
Entity Type:Organization
Organization Name:TENNESSEE TELEDERM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-565-1132
Mailing Address - Street 1:73 WHITE BRIDGE PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1444
Mailing Address - Country:US
Mailing Address - Phone:615-513-1959
Mailing Address - Fax:615-513-0498
Practice Address - Street 1:3500 JOHN A MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209
Practice Address - Country:US
Practice Address - Phone:615-513-1959
Practice Address - Fax:615-513-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty