Provider Demographics
NPI:1942337589
Name:CAROLAN, MELISSA ERIN (APN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ERIN
Last Name:CAROLAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HARDING PIKE
Mailing Address - Street 2:STE 530
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2094
Mailing Address - Country:US
Mailing Address - Phone:615-222-5500
Mailing Address - Fax:615-222-5601
Practice Address - Street 1:406 N WHITNEY AVE STE 5
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4243
Practice Address - Country:US
Practice Address - Phone:931-783-4269
Practice Address - Fax:931-372-0401
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525896Medicaid
KY7100423390Medicaid
TN4310834OtherBCBS
TN103I508823Medicare PIN