Provider Demographics
NPI:1891720470
Name:MAZERAC, CORRY TRANAS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CORRY
Middle Name:TRANAS
Last Name:MAZERAC
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CORRY
Other - Middle Name:L
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3950 NEW COVINGTON PIKE STE 110
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2595
Mailing Address - Country:US
Mailing Address - Phone:901-387-2900
Mailing Address - Fax:901-384-1645
Practice Address - Street 1:3950 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 110
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-387-2900
Practice Address - Fax:901-384-1645
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518458Medicaid