Provider Demographics
NPI:1952163396
Name:BRZECZEK, BOBBIE JO (CNM)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:BRZECZEK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2967
Mailing Address - Country:US
Mailing Address - Phone:423-492-7100
Mailing Address - Fax:
Practice Address - Street 1:1621 W MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2967
Practice Address - Country:US
Practice Address - Phone:423-492-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35623367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ090621Medicaid