Provider Demographics
NPI:1932180841
Name:EAGLE, MICHAEL FRANCIS (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:EAGLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-790-3290
Mailing Address - Fax:615-794-8845
Practice Address - Street 1:206 BEDFORD WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5526
Practice Address - Country:US
Practice Address - Phone:615-790-3290
Practice Address - Fax:615-794-8845
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1419363A00000X
TNPA1419363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970010580OtherRAILROAD
FLE30485ZMedicare ID - Type Unspecified
FL970010580OtherRAILROAD