Provider Demographics
NPI:1558136861
Name:AHMATGARAEVA, LUTSIA (FNP)
Entity Type:Individual
Prefix:
First Name:LUTSIA
Middle Name:
Last Name:AHMATGARAEVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LUTSIA
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3006 MARVIN CIR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-0565
Mailing Address - Country:US
Mailing Address - Phone:865-256-4330
Mailing Address - Fax:
Practice Address - Street 1:3006 MARVIN CIR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-0565
Practice Address - Country:US
Practice Address - Phone:865-256-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily