Provider Demographics
NPI:1659601425
Name:RECORD, MARGUERITE DIANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:DIANNE
Last Name:RECORD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MONOGARD DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3198
Mailing Address - Country:US
Mailing Address - Phone:931-450-4650
Mailing Address - Fax:262-372-5581
Practice Address - Street 1:227 MONOGARD DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3198
Practice Address - Country:US
Practice Address - Phone:931-685-6672
Practice Address - Fax:262-372-5581
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner