Healthcare Provider Details

I. General information

NPI: 1962558700
Provider Name (Legal Business Name): PATRICIA PORTILLA WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 CHARLOTTE PIKE
NASHVILLE TN
37209-3320
US

IV. Provider business mailing address

PO BOX 24730
NASHVILLE TN
37202-4730
US

V. Phone/Fax

Practice location:
  • Phone: 615-222-1900
  • Fax: 615-222-1917
Mailing address:
  • Phone: 615-386-2300
  • Fax: 615-386-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number12715
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number151993
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: