Provider Demographics
NPI:1417385212
Name:LANDERMAN, CAROL R (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:R
Last Name:LANDERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:R
Other - Last Name:LANDERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:1330 CEDAR LN BLDG B SUITE 900
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-1327
Mailing Address - Country:US
Mailing Address - Phone:931-455-2674
Mailing Address - Fax:931-455-8983
Practice Address - Street 1:1330 CEDAR LN STE 900
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2286
Practice Address - Country:US
Practice Address - Phone:931-455-2674
Practice Address - Fax:931-455-8983
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000018032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004882Medicaid