Healthcare Provider Details

I. General information

NPI: 1598225179
Provider Name (Legal Business Name): CHRISTINA MARIE LASSILA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N OCOEE ST
CLEVELAND TN
37311-3850
US

IV. Provider business mailing address

2350 N OCOEE ST
CLEVELAND TN
37311-3850
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-5554
  • Fax: 423-614-6116
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25625
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: