Healthcare Provider Details

I. General information

NPI: 1275177859
Provider Name (Legal Business Name): ROKSOLANA ODINETS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6784 HIGHWAY 411
BENTON TN
37307-4818
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 423-338-8995
  • Fax:
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-208-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26159
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: