Provider Demographics
NPI:1457607343
Name:FITZGERALD, TYPHANEE LYNETTE
Entity Type:Individual
Prefix:
First Name:TYPHANEE
Middle Name:LYNETTE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 POWELL PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7522
Mailing Address - Country:US
Mailing Address - Phone:615-369-0614
Mailing Address - Fax:615-369-0615
Practice Address - Street 1:205 POWELL PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7522
Practice Address - Country:US
Practice Address - Phone:615-369-0614
Practice Address - Fax:615-369-0615
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN611679780374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel