Healthcare Provider Details

I. General information

NPI: 1255575643
Provider Name (Legal Business Name): MANDY POLLACK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 DAVIS LN
LA FOLLETTE TN
37766-3118
US

IV. Provider business mailing address

8913 TOWN AND COUNTRY CIR # 1066
KNOXVILLE TN
37923-4931
US

V. Phone/Fax

Practice location:
  • Phone: 423-562-0760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number17069
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9245838
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberARNP9245838
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200141
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: