Provider Demographics
NPI:1245762384
Name:MUECKE, MOLLY (FNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MUECKE
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 1:5202 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1477
Mailing Address - Country:US
Mailing Address - Phone:615-873-4110
Mailing Address - Fax:
Practice Address - Street 1:5202 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-1477
Practice Address - Country:US
Practice Address - Phone:615-873-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22642363L00000X
TN0000200841390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner