Provider Demographics
NPI:1629271028
Name:WINFREY, JACKIE SUSNNE (APN)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:SUSNNE
Last Name:WINFREY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 WALLACE RD STE D
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8001
Mailing Address - Country:US
Mailing Address - Phone:615-832-2200
Mailing Address - Fax:615-832-2020
Practice Address - Street 1:341 WALLACE RD STE D
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8001
Practice Address - Country:US
Practice Address - Phone:615-832-2200
Practice Address - Fax:615-832-2020
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4298617163W00000X
TN19955363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse