Healthcare Provider Details

I. General information

NPI: 1699234195
Provider Name (Legal Business Name): HEATHER A MARVIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DONELSON AVE UNIT 424
OLD HICKORY TN
37138-3183
US

IV. Provider business mailing address

1101 DONELSON AVE UNIT 424
OLD HICKORY TN
37138-3183
US

V. Phone/Fax

Practice location:
  • Phone: 615-476-5656
  • Fax: 615-810-8516
Mailing address:
  • Phone: 615-476-5656
  • Fax: 615-810-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000034345
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019014
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: