Healthcare Provider Details

I. General information

NPI: 1992030050
Provider Name (Legal Business Name): TRACY L COFFEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N MAIN ST
BULLS GAP TN
37711-4735
US

IV. Provider business mailing address

7100 COMMERCE WAY SUITE 180
BRENTWOOD TN
37027-2851
US

V. Phone/Fax

Practice location:
  • Phone: 423-235-0063
  • Fax: 423-235-0066
Mailing address:
  • Phone: 615-465-7000
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14416
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: