Provider Demographics
NPI:1467894584
Name:FOGLE, CONNIE J (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:J
Last Name:FOGLE
Suffix:
Gender:F
Credentials:FNP-BC
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26110 EMERY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5788
Mailing Address - Country:US
Mailing Address - Phone:440-368-6868
Mailing Address - Fax:440-368-6866
Practice Address - Street 1:750 OLD HICKORY BLVD STE 1-262A
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4528
Practice Address - Country:US
Practice Address - Phone:615-994-8416
Practice Address - Fax:855-919-6233
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGR476AMedicare UPIN