Provider Demographics
NPI:1376022327
Name:BLOCKER, JEFFREY SHAWN (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SHAWN
Last Name:BLOCKER
Suffix:
Gender:M
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 BROOKMEADE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4085
Mailing Address - Country:US
Mailing Address - Phone:931-840-8525
Mailing Address - Fax:
Practice Address - Street 1:2150 BROOKMEADE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4085
Practice Address - Country:US
Practice Address - Phone:931-840-8525
Practice Address - Fax:931-840-8535
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily