Provider Demographics
NPI:1679449748
Name:POLK, JOAN (RN, CCM)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 17TH AVE S STE 605
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2260
Mailing Address - Country:US
Mailing Address - Phone:615-312-7048
Mailing Address - Fax:
Practice Address - Street 1:1005 17TH AVE S STE 605
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2260
Practice Address - Country:US
Practice Address - Phone:615-346-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47054163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator