Healthcare Provider Details

I. General information

NPI: 1962474825
Provider Name (Legal Business Name): JANE E GERTZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9031 CROSS PARK DR
KNOXVILLE TN
37923-4602
US

IV. Provider business mailing address

9031 CROSS PARK DR
KNOXVILLE TN
37923-4602
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-6880
  • Fax: 865-777-6881
Mailing address:
  • Phone: 865-777-6880
  • Fax: 865-777-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2028812
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-118334
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000020321
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: