Provider Demographics
NPI:1780686865
Name:MUSICK, MITZI DANIELA (ANP)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:DANIELA
Last Name:MUSICK
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:865-978-6182
Mailing Address - Fax:855-737-5542
Practice Address - Street 1:105 W STONE DR STE 3A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3365
Practice Address - Country:US
Practice Address - Phone:423-392-6200
Practice Address - Fax:423-390-4411
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000116388363LF0000X
VA0001162148363LF0000X
TNAPN0000007650363LF0000X
VA0024165213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000007650OtherADVANCED PRACTICE NURSE
TNRN0000116388OtherREGISTERED NURSE LICENSE