Healthcare Provider Details

I. General information

NPI: 1144136862
Provider Name (Legal Business Name): ETHAN F OSBURN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HAYES ST STE 200
NASHVILLE TN
37203-2689
US

IV. Provider business mailing address

2004 HAYES ST STE 200
NASHVILLE TN
37203-2689
US

V. Phone/Fax

Practice location:
  • Phone: 615-324-1600
  • Fax:
Mailing address:
  • Phone: 615-324-1600
  • Fax: 615-324-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7340
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: