Healthcare Provider Details

I. General information

NPI: 1659864650
Provider Name (Legal Business Name): ANDREA SUZANNE PROCTOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 22ND AVE N
NASHVILLE TN
37203-1949
US

IV. Provider business mailing address

5511 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7611
US

V. Phone/Fax

Practice location:
  • Phone: 615-251-8805
  • Fax:
Mailing address:
  • Phone: 615-994-1000
  • Fax: 615-994-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185100
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10456
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: