Provider Demographics
NPI:1720581390
Name:GUZMAN, MELISSA ANN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11029 EAGLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1472
Mailing Address - Country:US
Mailing Address - Phone:865-228-4733
Mailing Address - Fax:
Practice Address - Street 1:10857 HARDIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1410
Practice Address - Country:US
Practice Address - Phone:865-690-2682
Practice Address - Fax:866-529-5509
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000023704363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045208Medicaid