Healthcare Provider Details

I. General information

NPI: 1972896041
Provider Name (Legal Business Name): GLENDA TAYLOR ATKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLENDA MARIE TAYLOR

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 SPRING ST
DOVER TN
37058-3302
US

IV. Provider business mailing address

1021 SPRING ST
DOVER TN
37058-3302
US

V. Phone/Fax

Practice location:
  • Phone: 931-232-5329
  • Fax: 931-232-7247
Mailing address:
  • Phone: 931-232-5329
  • Fax: 931-232-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015772
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: