Healthcare Provider Details

I. General information

NPI: 1124375605
Provider Name (Legal Business Name): AMANDA MARIE CLABO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTWOOD PL STE 110
BRENTWOOD TN
37027-7554
US

IV. Provider business mailing address

1787 VETERANS BLVD STE 101
SEVIERVILLE TN
37862-6946
US

V. Phone/Fax

Practice location:
  • Phone: 615-206-2462
  • Fax:
Mailing address:
  • Phone: 865-428-2773
  • Fax: 865-428-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16748
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: