Healthcare Provider Details

I. General information

NPI: 1275036311
Provider Name (Legal Business Name): TENNILLE J BLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 STONECREST PKWY STE 130
SMYRNA TN
37167-6827
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-895-6500
  • Fax:
Mailing address:
  • Phone: 615-239-2018
  • Fax: 865-525-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: