Provider Demographics
NPI:1710254057
Name:BANGURA, JACQUELINE ANNA (DNP)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANNA
Last Name:BANGURA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6688 NOLENSVILLE RD STE 108-41
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8833
Mailing Address - Country:US
Mailing Address - Phone:615-396-8997
Mailing Address - Fax:
Practice Address - Street 1:5630 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6422
Practice Address - Country:US
Practice Address - Phone:615-396-8997
Practice Address - Fax:615-809-2062
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528608Medicaid
9926916OtherAETNA
1438566OtherCIGNA
4339887OtherBLUE CROSS BLUE SHIELD
01694655OtherAMERIGROUP
TN103I509620Medicare UPIN