Provider Demographics
NPI:1558461293
Name:CROSSLIN, CONNIE G (FNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:G
Last Name:CROSSLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4239
Mailing Address - Country:US
Mailing Address - Phone:615-373-2000
Mailing Address - Fax:615-425-2100
Practice Address - Street 1:515 STONECREST PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6826
Practice Address - Country:US
Practice Address - Phone:615-223-7227
Practice Address - Fax:615-425-2100
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3929841Medicaid
TN3929841Medicare ID - Type Unspecified
TN103I502788Medicare PIN
TNQ22833Medicare UPIN
TN103I502789Medicare PIN
TN3929841Medicaid
TN103I502790Medicare PIN