Provider Demographics
NPI:1730460262
Name:GROSCHEL-SNEAD, JEANNETTE M (NP)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:M
Last Name:GROSCHEL-SNEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:M
Other - Last Name:GROSCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:2210 SUTHERLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2337
Mailing Address - Country:US
Mailing Address - Phone:865-525-4333
Mailing Address - Fax:
Practice Address - Street 1:2210 SUTHERLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2337
Practice Address - Country:US
Practice Address - Phone:865-525-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9378061363L00000X
TN28103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW578ZOtherMEDICARE
FL013830000Medicaid
TNQ067976Medicaid