Healthcare Provider Details

I. General information

NPI: 1376387464
Provider Name (Legal Business Name): REGINA EYO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MURFREESBORO PIKE
ANTIOCH TN
37013-2789
US

IV. Provider business mailing address

4200 MURFREESBORO PIKE
ANTIOCH TN
37013-2789
US

V. Phone/Fax

Practice location:
  • Phone: 615-390-6775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35977
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: