Provider Demographics
NPI:1619454667
Name:MADORMO, JESSIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:MADORMO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5737
Mailing Address - Country:US
Mailing Address - Phone:203-232-5704
Mailing Address - Fax:
Practice Address - Street 1:6200 HIGHWAY 100 STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-4252
Practice Address - Country:US
Practice Address - Phone:615-815-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily