Healthcare Provider Details

I. General information

NPI: 1578934790
Provider Name (Legal Business Name): ZILLA F HENRICKSEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5194 HIGHWAY 100 STE 106
LYLES TN
37098-2822
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 209
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-1102
  • Fax: 931-670-1065
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129005
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN19374
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: