Healthcare Provider Details

I. General information

NPI: 1720858053
Provider Name (Legal Business Name): MONIKA EWELINA SAFARPOUR AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S MCCRARY ST
WOODBURY TN
37190-1420
US

IV. Provider business mailing address

635 LYONS FARM PKWY APT K1137
MURFREESBORO TN
37127-5882
US

V. Phone/Fax

Practice location:
  • Phone: 615-563-2891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number34539
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: