Provider Demographics
NPI:1851143267
Name:BISSADA, JENNIFER EMAD
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EMAD
Last Name:BISSADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-1910
Mailing Address - Country:US
Mailing Address - Phone:615-668-7955
Mailing Address - Fax:
Practice Address - Street 1:917 KIPLING DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1910
Practice Address - Country:US
Practice Address - Phone:615-668-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program