Provider Demographics
NPI:1952708406
Name:CALVARESE, STANTON II (NP-C)
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:
Last Name:CALVARESE
Suffix:II
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8055
Mailing Address - Country:US
Mailing Address - Phone:352-214-7290
Mailing Address - Fax:
Practice Address - Street 1:100 GLEN OAK BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3025
Practice Address - Country:US
Practice Address - Phone:352-214-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235060261QP2300X, 363LF0000X
TN19467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care