Provider Demographics
NPI:1295059186
Name:BAUMTROG, JODIE M (FNP)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:M
Last Name:BAUMTROG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JODIE
Other - Middle Name:M
Other - Last Name:ROOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:919 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3002
Mailing Address - Country:US
Mailing Address - Phone:615-791-7373
Mailing Address - Fax:
Practice Address - Street 1:919 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3002
Practice Address - Country:US
Practice Address - Phone:615-791-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily