Provider Demographics
NPI:1801060835
Name:SMALLWOOD, LISA ANJONETTE (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANJONETTE
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 CARLYLE CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1372
Mailing Address - Country:US
Mailing Address - Phone:615-310-1491
Mailing Address - Fax:
Practice Address - Street 1:542 UPTOWN SQ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0589
Practice Address - Country:US
Practice Address - Phone:615-310-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13419363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509897Medicaid
TN1509897Medicaid