Healthcare Provider Details

I. General information

NPI: 1912708611
Provider Name (Legal Business Name): SARA RENEE LANE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 E COLLEGE ST
DICKSON TN
37055-2032
US

IV. Provider business mailing address

718 E COLLEGE ST
DICKSON TN
37055-2032
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-7016
  • Fax:
Mailing address:
  • Phone: 615-560-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number38474
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: