Provider Demographics
NPI:1962019125
Name:BANYAN HEALTHCARE PLLC
Entity Type:Organization
Organization Name:BANYAN HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SZUCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-681-4762
Mailing Address - Street 1:5115 MARYLAND WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7512
Mailing Address - Country:US
Mailing Address - Phone:615-681-4762
Mailing Address - Fax:
Practice Address - Street 1:5115 MARYLAND WAY STE 120
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7512
Practice Address - Country:US
Practice Address - Phone:615-681-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty