Provider Demographics
NPI:1982085569
Name:DADISMAN, ANDREA (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DADISMAN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2277 WILMA RUDOLPH BLVD STE C
Mailing Address - Street 2:#273
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:910-568-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN196462163W00000X
TN19394363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse