Provider Demographics
NPI:1467179283
Name:CONDE, LAUREN MITZI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MITZI
Last Name:CONDE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MITZI
Other - Last Name:INGLESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:518 CROOKED STICK DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-9647
Mailing Address - Country:US
Mailing Address - Phone:865-724-8587
Mailing Address - Fax:
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6900
Practice Address - Country:US
Practice Address - Phone:865-724-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner