Healthcare Provider Details

I. General information

NPI: 1063962728
Provider Name (Legal Business Name): AMANDA A. CANTWELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CHEROKEE ST STE 3
JONESBOROUGH TN
37659-5599
US

IV. Provider business mailing address

501 N CHEROKEE ST STE 3
JONESBOROUGH TN
37659-5599
US

V. Phone/Fax

Practice location:
  • Phone: 423-753-0744
  • Fax: 423-753-4997
Mailing address:
  • Phone: 423-753-0744
  • Fax: 423-753-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21722
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174210
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: