Provider Demographics
NPI:1881017481
Name:SCATAMACCHIA, CAROLYN (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SCATAMACCHIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 POPLAR AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4806
Mailing Address - Country:US
Mailing Address - Phone:901-843-1045
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-843-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily