Healthcare Provider Details

I. General information

NPI: 1114891710
Provider Name (Legal Business Name): IRINA TOLLERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 FRIST BLVD
HERMITAGE TN
37076-2053
US

IV. Provider business mailing address

437 STONE CHIMNEY CT
NASHVILLE TN
37214-4736
US

V. Phone/Fax

Practice location:
  • Phone: 615-316-3000
  • Fax:
Mailing address:
  • Phone: 615-316-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number124057
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: