Provider Demographics
NPI:1801468509
Name:AUSTIN, LAVINIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 UNION CAMP RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-3718
Mailing Address - Country:US
Mailing Address - Phone:615-633-6867
Mailing Address - Fax:
Practice Address - Street 1:207 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1710
Practice Address - Country:US
Practice Address - Phone:615-666-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN29635OtherAPRN LICENSE