Healthcare Provider Details

I. General information

NPI: 1487973335
Provider Name (Legal Business Name): LUCILLE R VARA APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 PARKSIDE DR STE 331
KNOXVILLE TN
37934-1922
US

IV. Provider business mailing address

10800 PARKSIDE DR STE 331
KNOXVILLE TN
37934-1922
US

V. Phone/Fax

Practice location:
  • Phone: 865-392-3400
  • Fax: 865-392-3449
Mailing address:
  • Phone: 865-392-3400
  • Fax: 865-392-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000014903
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: