Provider Demographics
NPI:1356558449
Name:MANSFIELD, GINA T (NP)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:T
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3895
Mailing Address - Country:US
Mailing Address - Phone:615-824-4400
Mailing Address - Fax:615-824-6477
Practice Address - Street 1:181 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3895
Practice Address - Country:US
Practice Address - Phone:615-824-4400
Practice Address - Fax:615-824-6477
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39284751OtherMEDICARE PTAN
TNS93145Medicare UPIN