Provider Demographics
NPI:1821775024
Name:TIETGENS, ALEXA LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:LEIGH
Last Name:TIETGENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 WINDSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-6215
Mailing Address - Country:US
Mailing Address - Phone:931-244-5434
Mailing Address - Fax:
Practice Address - Street 1:3441 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2539
Practice Address - Country:US
Practice Address - Phone:615-769-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily