Provider Demographics
NPI:1780686865
Name:MUSICK, MITZI DANIELA (ANP)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:DANIELA
Last Name:MUSICK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:865-978-6182
Mailing Address - Fax:855-737-5542
Practice Address - Street 1:5201 KINGSTON PIKE STE 6
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-978-6182
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165213363LF0000X
TNRN0000116388363LF0000X
VA0001162148363LF0000X
TNAPN0000007650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000116388OtherREGISTERED NURSE LICENSE
TNAPN0000007650OtherADVANCED PRACTICE NURSE