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NPI Code Detail

MEDICARE: JACKIE SUSNNE WINFREY APN

MEDICARE: JACKIE SUSNNE WINFREY APN
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
1163W00000XRegistered Nurse4298617TN
2363L00000XNurse Practitioner19955TN

General Provider Information

NPI Number : 1629271028
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE SUSNNE WINFREY APN
Provider Business Mailing Address
First Line : 341 WALLACE RD STE D
Second Line :
City : NASHVILLE
State : TN
Zip : 37211-8001
Country : US
Telephone Number : 615-832-2200
Fax Number : 615-832-2020
Provider Business Practice Location Address
First Line : 341 WALLACE RD STE D
Second Line :
City : NASHVILLE
State : TN
Zip : 37211-8001
Country : US
Telephone Number : 615-832-2200
Fax Number : 615-832-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2007
Last Update Date : 07/21/2022

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