Provider Demographics
NPI:1659876324
Name:NYLAND-HENDERSON, JOANNA LUCY (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LUCY
Last Name:NYLAND-HENDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RELIANCE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1734
Mailing Address - Country:US
Mailing Address - Phone:615-554-0640
Mailing Address - Fax:
Practice Address - Street 1:131 RELIANCE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1734
Practice Address - Country:US
Practice Address - Phone:615-554-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant