Provider Demographics
NPI:1609275221
Name:MATZ, DAWN (FNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MATZ
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 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:901-203-2901
Mailing Address - Fax:
Practice Address - Street 1:6570 STAGE RD
Practice Address - Street 2:STE 160
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2839
Practice Address - Country:US
Practice Address - Phone:901-591-1590
Practice Address - Fax:901-552-4289
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1035I01196Medicare PIN