Provider Demographics
NPI:1972070548
Name:TICE, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1062 HOLLY LEIGH CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6102
Mailing Address - Country:US
Mailing Address - Phone:901-647-4791
Mailing Address - Fax:
Practice Address - Street 1:6799 GREAT OAKS RD STE 250
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-2584
Practice Address - Country:US
Practice Address - Phone:901-821-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903006363LF0000X
TN25061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily