Healthcare Provider Details

I. General information

NPI: 1780109967
Provider Name (Legal Business Name): JEANNE CAITLYN ENSTROM AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 07/21/2022
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MEDICAL CENTER DR
NASHVILLE TN
37232-0004
US

IV. Provider business mailing address

1211 MEDICAL CENTER DR
NASHVILLE TN
37232-0004
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-4665
  • Fax:
Mailing address:
  • Phone: 615-343-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number23013
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: