Provider Demographics
NPI:1801595764
Name:POLMAN, AMANDA DENISE (RN, BSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DENISE
Last Name:POLMAN
Suffix:
Gender:F
Credentials:RN, BSN, FNP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:DENISE
Other - Last Name:POLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN, FNP
Mailing Address - Street 1:701 E REELFOOT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5886
Mailing Address - Country:US
Mailing Address - Phone:731-885-9687
Mailing Address - Fax:731-885-6643
Practice Address - Street 1:701 E REELFOOT AVE STE 100
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5886
Practice Address - Country:US
Practice Address - Phone:731-885-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000035799363LF0000X
TNRN0000195881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily