Healthcare Provider Details

I. General information

NPI: 1700223922
Provider Name (Legal Business Name): PATRICE MICHELLE CYNTHIA ENYONG MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 AIRLINE RD
ARLINGTON TN
38002-9579
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 901-742-2857
  • Fax: 901-742-2858
Mailing address:
  • Phone: 877-852-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19577
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: