Provider Demographics
NPI:1275193328
Name:MAGNOTTI, JODI LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:MAGNOTTI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:ZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3833 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 EASTMORELAND AVE STE 585
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7506
Practice Address - Country:US
Practice Address - Phone:901-276-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN26024Medicaid