Provider Demographics
NPI:1568022556
Name:SWANN, SEAN TYLER
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:TYLER
Last Name:SWANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 FARRELL ST.
Mailing Address - Street 2:
Mailing Address - City:NIOTA
Mailing Address - State:TN
Mailing Address - Zip Code:37826
Mailing Address - Country:US
Mailing Address - Phone:423-667-3600
Mailing Address - Fax:
Practice Address - Street 1:1021 FARRELL ST.
Practice Address - Street 2:
Practice Address - City:NIOTA
Practice Address - State:TN
Practice Address - Zip Code:37826
Practice Address - Country:US
Practice Address - Phone:423-667-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily