Provider Demographics
NPI:1750492310
Name:HAEBERLE, PATRICIA K (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:HAEBERLE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1317
Mailing Address - Country:US
Mailing Address - Phone:615-329-7878
Mailing Address - Fax:615-329-7899
Practice Address - Street 1:2010 CHURCH ST
Practice Address - Street 2:STE. 700
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2012
Practice Address - Country:US
Practice Address - Phone:615-329-7878
Practice Address - Fax:615-329-7899
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17754363LA2200X
FLARNP9246511363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004691Medicaid
TNP01333431OtherRR MEDICARE
TN6015797OtherBLUE CROSS-BLUE SHIELD
TN6015797OtherBLUE CROSS-BLUE SHIELD
FLP01225999Medicare PIN
FLAC500YMedicare PIN