Provider Demographics
NPI:1194036327
Name:VANN, MARK A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:VANN
Suffix:
Gender:M
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 1:2008 DECHERD BLVD.
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324
Mailing Address - Country:US
Mailing Address - Phone:931-962-9000
Mailing Address - Fax:931-967-1791
Practice Address - Street 1:2008 DECHERD BLVD
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3818
Practice Address - Country:US
Practice Address - Phone:931-962-9000
Practice Address - Fax:931-967-1791
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily