Healthcare Provider Details

I. General information

NPI: 1780095109
Provider Name (Legal Business Name): MARK VANN FNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N WOODLAND ST
MANCHESTER TN
37355-1573
US

IV. Provider business mailing address

115 N WOODLAND ST
MANCHESTER TN
37355-1573
US

V. Phone/Fax

Practice location:
  • Phone: 931-723-7909
  • Fax:
Mailing address:
  • Phone: 931-723-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPN0000015060
License Number StateTN

VIII. Authorized Official

Name: MARK VANN
Title or Position: OWNER
Credential: FNP
Phone: 931-723-7909