Provider Demographics
NPI:1497271720
Name:MILLARD, MARY ANN MARTIN (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:MARTIN
Last Name:MILLARD
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5646 AVENWOOD CIR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-8234
Mailing Address - Country:US
Mailing Address - Phone:423-584-9832
Mailing Address - Fax:
Practice Address - Street 1:645 PAUL HUFF PKWY NW STE 105
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3150
Practice Address - Country:US
Practice Address - Phone:423-790-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily