Provider Demographics
NPI:1710050091
Name:COLVIN, JENNIFER A (ANP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:COLVIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1839
Mailing Address - Country:US
Mailing Address - Phone:865-331-2020
Mailing Address - Fax:865-331-1976
Practice Address - Street 1:501 19TH ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1839
Practice Address - Country:US
Practice Address - Phone:865-331-2020
Practice Address - Fax:865-331-1976
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8095363LW0102X
TN128888363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004379Medicaid