Healthcare Provider Details

I. General information

NPI: 1649094988
Provider Name (Legal Business Name): ERVIN GARCIA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 CANE RIDGE PKWY STE 112
ANTIOCH TN
37013-6043
US

IV. Provider business mailing address

4071 CANE RIDGE PKWY STE 112
ANTIOCH TN
37013-6043
US

V. Phone/Fax

Practice location:
  • Phone: 615-731-8390
  • Fax: 615-731-8391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37649
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number274652
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: