Provider Demographics
NPI:1891577953
Name:ANDERSON, DEMESHA ANTWANETTE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEMESHA
Middle Name:ANTWANETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEDICAL CENTER PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3237
Mailing Address - Country:US
Mailing Address - Phone:615-867-5028
Mailing Address - Fax:
Practice Address - Street 1:1840 MEDICAL CENTER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3237
Practice Address - Country:US
Practice Address - Phone:615-867-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily