Provider Demographics
NPI:1659669497
Name:FREIRE-BOZEMAN, CARRIE PATRICIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:PATRICIA
Last Name:FREIRE-BOZEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 E WEISGARBER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2677
Mailing Address - Country:US
Mailing Address - Phone:865-579-0552
Mailing Address - Fax:865-541-1003
Practice Address - Street 1:1128 E WEISGARBER RD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2677
Practice Address - Country:US
Practice Address - Phone:865-579-0552
Practice Address - Fax:865-934-2680
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531066Medicaid
TN103I502327Medicare PIN