Provider Demographics
NPI:1336294016
Name:ROLAND, EDWARD C
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:ROLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8861 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5002
Mailing Address - Country:US
Mailing Address - Phone:865-357-8861
Mailing Address - Fax:865-357-8866
Practice Address - Street 1:8861 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5002
Practice Address - Country:US
Practice Address - Phone:865-435-7886
Practice Address - Fax:865-357-8866
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000153775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner