Provider Demographics
NPI:1396350542
Name:SARAVANAKUMAR, GANGAGOWRI (APRN, FNP B-C)
Entity type:Individual
Prefix:
First Name:GANGAGOWRI
Middle Name:
Last Name:SARAVANAKUMAR
Suffix:
Gender:F
Credentials:APRN, FNP B-C
Other - Prefix:
Other - First Name:GANGAGOWRI
Other - Middle Name:
Other - Last Name:LAKSHMANAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9658 WOODLAND RUN LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6612
Mailing Address - Country:US
Mailing Address - Phone:901-604-8169
Mailing Address - Fax:
Practice Address - Street 1:9658 WOODLAND RUN LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6612
Practice Address - Country:US
Practice Address - Phone:901-604-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily