Provider Demographics
NPI:1760806632
Name:VERGARA, JADE POWELL (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:POWELL
Last Name:VERGARA
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:POWELL
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-C
Mailing Address - Street 1:347 WOODYCREST AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2520
Practice Address - Country:US
Practice Address - Phone:615-822-3000
Practice Address - Fax:615-348-0109
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18347363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health