Healthcare Provider Details

I. General information

NPI: 1740781483
Provider Name (Legal Business Name): REGINA ANN DANCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 04/01/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11612 CHAPMAN HWY UNIT B
SEYMOUR TN
37865-5083
US

IV. Provider business mailing address

11612 CHAPMAN HWY UNIT B
SEYMOUR TN
37865-5083
US

V. Phone/Fax

Practice location:
  • Phone: 423-888-8506
  • Fax: 423-888-8506
Mailing address:
  • Phone: 423-888-8506
  • Fax: 423-888-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23937
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: