Provider Demographics
NPI:1134362452
Name:SCHOLZE, POLLY ANN (FNP)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:ANN
Last Name:SCHOLZE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:POLLYANN
Other - Middle Name:
Other - Last Name:SCHOLZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:965 RIDGE LAKE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7424 US HIGHWAY 64 STE 111
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-8937
Practice Address - Country:US
Practice Address - Phone:901-372-3573
Practice Address - Fax:901-383-2150
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14073363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012564Medicaid
MS00722363Medicaid
TN3345714Medicare PIN