Provider Demographics
NPI:1821452392
Name:ANGLIN, ALEXA RAE (DNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:RAE
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S HARTMANN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4787
Mailing Address - Country:US
Mailing Address - Phone:615-288-0075
Mailing Address - Fax:
Practice Address - Street 1:365 S HARTMANN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4787
Practice Address - Country:US
Practice Address - Phone:615-288-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21115363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics