Provider Demographics
NPI:1023788635
Name:LANG, ROBERT BRECK (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRECK
Last Name:LANG
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 WESTLAND DR SW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-8163
Mailing Address - Country:US
Mailing Address - Phone:423-478-1970
Mailing Address - Fax:
Practice Address - Street 1:2020 WESTLAND DR SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-8163
Practice Address - Country:US
Practice Address - Phone:423-478-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily