Provider Demographics
NPI:1952606055
Name:MEREDITH, NICOLE TABRIZI (APN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TABRIZI
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:BERENGI
Other - Last Name:TABRIZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:8970 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8231
Practice Address - Country:US
Practice Address - Phone:901-794-5806
Practice Address - Fax:901-794-7922
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner