Healthcare Provider Details

I. General information

NPI: 1144412958
Provider Name (Legal Business Name): JENNIFER LYNN EVANGELIST APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 W COLLEGE ST
GREENBRIER TN
37073-5564
US

IV. Provider business mailing address

1437 W COLLEGE ST
GREENBRIER TN
37073-5564
US

V. Phone/Fax

Practice location:
  • Phone: 615-293-1500
  • Fax:
Mailing address:
  • Phone: 615-293-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAPN0000011558
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55974
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: