Provider Demographics
NPI:1780756924
Name:FRATTA, AGNES COUGHLIN (FNP)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:COUGHLIN
Last Name:FRATTA
Suffix:
Gender:
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 GERMANTOWN CT STE 100
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4274
Practice Address - Country:US
Practice Address - Phone:901-435-8550
Practice Address - Fax:901-478-0781
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN12377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12377OtherSTATE LICENSE