Provider Demographics
NPI:1679353742
Name:STREET, TIMOTHY CHAD (RN, CC-P)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CHAD
Last Name:STREET
Suffix:
Gender:M
Credentials:RN, CC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 S RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3935
Mailing Address - Country:US
Mailing Address - Phone:423-213-2192
Mailing Address - Fax:
Practice Address - Street 1:107 NATCHEZ PARK DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-9013
Practice Address - Country:US
Practice Address - Phone:615-326-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN242473163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency