Provider Demographics
NPI:1982009825
Name:WEIDA, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WEIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-284-4646
Mailing Address - Fax:615-284-4675
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-4646
Practice Address - Fax:615-284-4675
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6032774OtherBLUE CROSS/BLUE SHIELD
TNQ010595Medicaid
TNP01402322OtherRR MEDICARE
TNP01402322OtherRR MEDICARE