MEDICARE: LISA NICOLE TRAIL ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	14229	TN
2	363L00000X	Nurse Practitioner	APN14229	TN

General Provider Information

NPI Number	:	1174751671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NICOLE TRAIL ANP-BC

Provider Business Mailing Address
First Line	:	ONE GI CREDENTIALING DEPARTMENT
Second Line	:	PO BOX 381468
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-2487
Country	:	US
Telephone Number	:	615-896-6996
Fax Number	:	615-896-6985

Provider Business Practice Location Address
First Line	:	1115B DOW ST
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-2487
Country	:	US
Telephone Number	:	615-896-6996
Fax Number	:	615-896-6985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	02/28/2025

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