Provider Demographics
NPI:1417470279
Name:AQUARI, INC.
Entity Type:Organization
Organization Name:AQUARI, INC.
Other - Org Name:LICE CLINICS KNOXVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TIPPENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-368-8759
Mailing Address - Street 1:4006 SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5103
Mailing Address - Country:US
Mailing Address - Phone:865-245-5333
Mailing Address - Fax:
Practice Address - Street 1:4006 SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5103
Practice Address - Country:US
Practice Address - Phone:865-245-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty