Provider Demographics
NPI:1891430617
Name:CONNELL, TINA (NP)
Entity Type:Individual
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First Name:TINA
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:257 BANCORP SOUTH PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7582
Mailing Address - Country:US
Mailing Address - Phone:731-512-1264
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:620 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:731-541-5000
Practice Address - Fax:731-660-8739
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
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Provider Licenses
StateLicense IDTaxonomies
TN31501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily