Provider Demographics
NPI:1891701017
Name:HUGHEY, MARISA S (NP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:S
Last Name:HUGHEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:SUMMER
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:615-284-2222
Mailing Address - Fax:
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2062
Practice Address - Country:US
Practice Address - Phone:615-391-3971
Practice Address - Fax:615-391-4725
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN137399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506648Medicaid
TN1506648Medicaid
TN10350I7093Medicare PIN