Provider Demographics
NPI:1376512889
Name:PROFFITT, ALVINIA C (APN)
Entity Type:Individual
Prefix:
First Name:ALVINIA
Middle Name:C
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ALVINIA
Other - Middle Name:
Other - Last Name:ZIEGENFUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 BROOKVIEW CENTRE WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4049
Mailing Address - Country:US
Mailing Address - Phone:800-342-2898
Mailing Address - Fax:
Practice Address - Street 1:265 BROOKVIEW CENTRE WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4049
Practice Address - Country:US
Practice Address - Phone:800-342-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3642311Medicare ID - Type Unspecified
TNQ61386Medicare UPIN