Healthcare Provider Details

I. General information

NPI: 1417470279
Provider Name (Legal Business Name): AQUARI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 SUTHERLAND AVE
KNOXVILLE TN
37919-5103
US

IV. Provider business mailing address

4006 SUTHERLAND AVE
KNOXVILLE TN
37919-5103
US

V. Phone/Fax

Practice location:
  • Phone: 865-245-5333
  • Fax:
Mailing address:
  • Phone: 865-245-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER LYNN TIPPENS
Title or Position: PRESIDENT
Credential:
Phone: 865-368-8759