Healthcare Provider Details

I. General information

NPI: 1295222586
Provider Name (Legal Business Name): ZHANNA YURIEVNA EFFLANDT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZHANNA YURIEVNA DMITRIEVA

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLINCH AVE STE 130
KNOXVILLE TN
37916-2224
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3111
  • Fax: 865-541-8629
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23697
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: