Healthcare Provider Details

I. General information

NPI: 1316473754
Provider Name (Legal Business Name): TUESDAY NICOLE SCALF PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVENUE SUITE 510
KNOXVILLE TN
37916
US

IV. Provider business mailing address

840 WOOD HARBOUR ROAD
KNOXVILLE TN
37934
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax:
Mailing address:
  • Phone: 865-414-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22595
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: