Provider Demographics
NPI:1952908154
Name:VANCE, COURTNEY DIANE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:DIANE
Last Name:VANCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415000-MSC8179
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-8179
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:1940 ALCOA HWY STE E310
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2267
Practice Address - Country:US
Practice Address - Phone:655-442-8008
Practice Address - Fax:865-544-2800
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28314363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner