Healthcare Provider Details

I. General information

NPI: 1083438568
Provider Name (Legal Business Name): TASHA RUFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHLAND CIRCLE DR
PORTLAND TN
37148-4918
US

IV. Provider business mailing address

617 COLES FERRY RD
GALLATIN TN
37066-6218
US

V. Phone/Fax

Practice location:
  • Phone: 615-325-9263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number37607
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: