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General NPI Number Information
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NPI Number | 1053685362
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Entity Type | Individual
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Provider Name | LISA ANN JAYCOX ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 3001 LAKE BROOK BLVD STE 101
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City | KNOXVILLE
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State | TN
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Zip | 37909-3761
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Country | US
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Telephone | 865-374-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 LAKE BROOK BLVD STE 101
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City | KNOXVILLE
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State | TN
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Zip | 37909-3761
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Country | US
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Telephone | 865-374-0600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9208812
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9208812
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 31303
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License Number State | TN
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