Provider Demographics
NPI:1891013942
Name:VINCELLI, NAN (PA-C)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:
Last Name:VINCELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 CALLAWAY PARK PL
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5467
Mailing Address - Country:US
Mailing Address - Phone:615-424-0758
Mailing Address - Fax:
Practice Address - Street 1:1332 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3922
Practice Address - Country:US
Practice Address - Phone:615-984-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant