Provider Demographics
NPI:1518955699
Name:WARREN, TODD A (NP, ATC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:WARREN
Suffix:
Gender:M
Credentials:NP, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HENSLEE DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2166
Mailing Address - Country:US
Mailing Address - Phone:615-375-8287
Mailing Address - Fax:615-375-8315
Practice Address - Street 1:415 HENSLEE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2166
Practice Address - Country:US
Practice Address - Phone:615-375-8287
Practice Address - Fax:615-375-8315
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7894363LA2100X
TN7894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4342779OtherBCBS
TN1531324Medicaid
TN1531324Medicaid
TN10350I6967Medicare PIN
TN3908202Medicare PIN