Provider Demographics
NPI:1821455510
Name:RAGUSA, JENNIFER TOULON (MSN, RN, FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TOULON
Last Name:RAGUSA
Suffix:
Gender:F
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SEABOARD LN STE A10
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8221
Mailing Address - Country:US
Mailing Address - Phone:629-300-5145
Mailing Address - Fax:629-252-7889
Practice Address - Street 1:130 SEABOARD LN STE A10
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8221
Practice Address - Country:US
Practice Address - Phone:629-300-5145
Practice Address - Fax:629-252-7889
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003395207Q00000X
TN31694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE92397Medicare UPIN
CAW20055Medicare PIN
CAW20055Medicare PIN