Provider Demographics
NPI:1326384991
Name:ROBERTS, ENGLISH PAIGE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ENGLISH
Middle Name:PAIGE
Last Name:ROBERTS
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 1:17619 STATE HIGHWAY 58 N STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-7882
Mailing Address - Country:US
Mailing Address - Phone:423-334-2300
Mailing Address - Fax:423-454-0125
Practice Address - Street 1:17619 STATE HIGHWAY 58 N STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7882
Practice Address - Country:US
Practice Address - Phone:423-334-2300
Practice Address - Fax:423-454-0125
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-29
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN17332363LP2300X, 363LF0000X, 363L00000X
TN156032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007400Medicaid
TNQ007400Medicaid