Healthcare Provider Details

I. General information

NPI: 1962512483
Provider Name (Legal Business Name): ROBIN R BLACK CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 EAST MAIN ST
ERIN TN
37061
US

IV. Provider business mailing address

PO BOX 469
ERIN TN
37061
US

V. Phone/Fax

Practice location:
  • Phone: 931-289-4201
  • Fax: 931-289-4204
Mailing address:
  • Phone: 931-289-4201
  • Fax: 931-289-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN6178
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: