Healthcare Provider Details

I. General information

NPI: 1871416396
Provider Name (Legal Business Name): AXIOM PERFORMANCE MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 STATE ST APT 324
SANTA BARBARA CA
93105-5642
US

IV. Provider business mailing address

3885 STATE ST APT 324
SANTA BARBARA CA
93105-5642
US

V. Phone/Fax

Practice location:
  • Phone: 615-477-0226
  • Fax:
Mailing address:
  • Phone: 615-477-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TMOTHY SHAWN DANNELS
Title or Position: OWNER
Credential: FNP
Phone: 615-477-0226