Healthcare Provider Details

I. General information

NPI: 1922289362
Provider Name (Legal Business Name): JENNIFER TILLMAN STRIBLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 03/11/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 GALLERIA BLVD
BRENTWOOD TN
37027-2926
US

IV. Provider business mailing address

1623 GALLERIA BLVD
BRENTWOOD TN
37027-2926
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-8800
  • Fax: 615-771-5664
Mailing address:
  • Phone: 615-771-8800
  • Fax: 615-771-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101243424
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD0000049052
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number127903
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101243424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: