Healthcare Provider Details

I. General information

NPI: 1215369921
Provider Name (Legal Business Name): VICTORIA LYNN OSBORNE F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GAY ST
ERWIN TN
37650-1227
US

IV. Provider business mailing address

PO BOX 399
ERWIN TN
37650-0399
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-6141
  • Fax: 423-743-1083
Mailing address:
  • Phone: 423-743-6141
  • Fax: 423-743-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000017830
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: