MEDICARE: IGOR CVJETKOVIC FNP-C

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	363LF0000X	Family Nurse Practitioner	33679	TN

General Provider Information

NPI Number	:	1194428466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR CVJETKOVIC FNP-C

Provider Business Mailing Address
First Line	:	2620 ELM HILL PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8141 HIGHWAY 100
Second Line	:
City	:	BELLEVUE
State	:	TN
Zip	:	37221-4213
Country	:	US
Telephone Number	:	615-515-0026
Fax Number	:

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

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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