Provider Demographics
NPI:1407115108
Name:RACINE, CHERYL LYNN (APN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:RACINE
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, FNP
Mailing Address - Street 1:1580 MINT MEADOWS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-2542
Mailing Address - Country:US
Mailing Address - Phone:865-384-5166
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:1580 MINT MEADOWS DRIVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-2542
Practice Address - Country:US
Practice Address - Phone:865-384-5166
Practice Address - Fax:865-380-4095
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16462363LF0000X
TNAPN-16462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000287Medicaid
TN1035I02400Medicare PIN