Provider Demographics
NPI:1710234489
Name:WARNER, JACQUELYN RENEE (FNP-BC, IFMCP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:RENEE
Last Name:WARNER
Suffix:
Gender:F
Credentials:FNP-BC, IFMCP
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:RENEE
Other - Last Name:FAUNCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:100 POWELL PL # 1731
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3622
Mailing Address - Country:US
Mailing Address - Phone:615-257-9566
Mailing Address - Fax:828-376-0673
Practice Address - Street 1:7155 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9461
Practice Address - Country:US
Practice Address - Phone:615-549-5586
Practice Address - Fax:615-450-6883
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily