Healthcare Provider Details

I. General information

NPI: 1093526113
Provider Name (Legal Business Name): MADELINE HARLAND FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N STATE OF FRANKLIN RD STE 202
JOHNSON CITY TN
37604-6063
US

IV. Provider business mailing address

310 N STATE OF FRANKLIN RD STE 202
JOHNSON CITY TN
37604-6063
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-7111
  • Fax:
Mailing address:
  • Phone: 423-929-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38005
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: