Healthcare Provider Details

I. General information

NPI: 1619858644
Provider Name (Legal Business Name): TONI ANDRADE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXETER RD STE 250
GERMANTOWN TN
38138-3931
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-5864
  • Fax: 901-767-6591
Mailing address:
  • Phone: 901-226-4003
  • Fax: 901-227-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number229603
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907878
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number39914
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: