Provider Demographics
NPI:1245983030
Name:HERMITAGE FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:HERMITAGE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELBERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-874-9888
Mailing Address - Street 1:4243 LEBANON PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2170
Mailing Address - Country:US
Mailing Address - Phone:615-874-9888
Mailing Address - Fax:615-883-6899
Practice Address - Street 1:4243 LEBANON PIKE STE A
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2170
Practice Address - Country:US
Practice Address - Phone:615-874-9888
Practice Address - Fax:615-883-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty