Provider Demographics
NPI:1629238340
Name:JARQUIN-VALDIVIA, TAWANA RENA (ANP-BC)
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:RENA
Last Name:JARQUIN-VALDIVIA
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A-0118 MCN
Mailing Address - Street 2:VANDERBILT NEUROLOGY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232
Mailing Address - Country:US
Mailing Address - Phone:615-936-1354
Mailing Address - Fax:
Practice Address - Street 1:A-0118 MCN
Practice Address - Street 2:VANDERBILT NEUROLOGY
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2551
Practice Address - Country:US
Practice Address - Phone:615-936-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13459363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health