Healthcare Provider Details

I. General information

NPI: 1932214889
Provider Name (Legal Business Name): TINA QUENTELLA HARRIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR SUITE 200
CHATTANOOGA TN
37404-1108
US

IV. Provider business mailing address

PO BOX 440261
NASHVILLE TN
37244-0261
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-1844
  • Fax: 423-624-2226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN00000012185
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN161065
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: