Healthcare Provider Details

I. General information

NPI: 1336305440
Provider Name (Legal Business Name): VANESSA ANN SHAFFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA ANN LALOGGIA NP

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

140 W 7TH ST
COOKEVILLE TN
38501-1726
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-2143
  • Fax: 931-783-2152
Mailing address:
  • Phone: 931-783-5582
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number33074
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: