Healthcare Provider Details

I. General information

NPI: 1043413123
Provider Name (Legal Business Name): MRS. CARLINE ALVARES FANFAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ORIEL AVE
NASHVILLE TN
37210-4910
US

IV. Provider business mailing address

103 LINCOLN LN
SMYRNA TN
37167-7216
US

V. Phone/Fax

Practice location:
  • Phone: 615-862-7297
  • Fax: 615-880-2194
Mailing address:
  • Phone: 615-862-7940
  • Fax: 615-880-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000105065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: