Healthcare Provider Details

I. General information

NPI: 1053563353
Provider Name (Legal Business Name): MRS. CAROL HOFFMAN BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SAINT CLAIR ST
MURFREESBORO TN
37130-2848
US

IV. Provider business mailing address

325 SAINT CLAIR ST
MURFREESBORO TN
37130-2848
US

V. Phone/Fax

Practice location:
  • Phone: 615-848-2550
  • Fax: 615-904-6511
Mailing address:
  • Phone: 615-848-2550
  • Fax: 615-904-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN0000106166
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: