Provider Demographics
NPI:1679803399
Name:HUMPHREY, TEREZA (NP)
Entity Type:Individual
Prefix:
First Name:TEREZA
Middle Name:
Last Name:HUMPHREY
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 1:4230 HARDING PIKE
Mailing Address - Street 2:SUITE 805E
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-425-7605
Mailing Address - Fax:615-916-3953
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 805E
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-425-7605
Practice Address - Fax:615-916-3953
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014327363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN 14327OtherLICENSE
TN1517290Medicaid