Provider Demographics
NPI:1265818983
Name:BLACKBURN, JATEUM MAUREE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JATEUM
Middle Name:MAUREE
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 CHAMBLISS AVE NW STE 400
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3861
Mailing Address - Country:US
Mailing Address - Phone:423-476-5002
Mailing Address - Fax:423-476-5969
Practice Address - Street 1:2253 CHAMBLISS AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3861
Practice Address - Country:US
Practice Address - Phone:423-476-5002
Practice Address - Fax:423-476-5969
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily