Provider Demographics
NPI:1659864650
Name:PROCTOR, ANDREA SUZANNE (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUZANNE
Last Name:PROCTOR
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 1:5511 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7611
Mailing Address - Country:US
Mailing Address - Phone:615-994-1000
Mailing Address - Fax:615-994-0100
Practice Address - Street 1:402 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1949
Practice Address - Country:US
Practice Address - Phone:615-251-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185100363LF0000X
TN10456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily