Healthcare Provider Details

I. General information

NPI: 1417258898
Provider Name (Legal Business Name): AZRA BLAZEVIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MCCALLIE AVE
CHATTANOOGA TN
37404-3258
US

IV. Provider business mailing address

314 CENTURY DR
ROSSVILLE GA
30741-4835
US

V. Phone/Fax

Practice location:
  • Phone: 865-539-8008
  • Fax:
Mailing address:
  • Phone: 423-290-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015264
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: