Provider Demographics
NPI:1780866335
Name:AGUAYO, BOBBY PATRICK (FNP)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:PATRICK
Last Name:AGUAYO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HWY 70 E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-7039
Mailing Address - Country:US
Mailing Address - Phone:615-810-8440
Mailing Address - Fax:615-810-8441
Practice Address - Street 1:118 HWY 70 E
Practice Address - Street 2:SUITE 6
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7039
Practice Address - Country:US
Practice Address - Phone:615-810-8440
Practice Address - Fax:615-810-8441
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514542Medicaid
TN3720916OtherMEDICARE
TN1514542Medicaid