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General NPI Number Information
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NPI Number | 1114734613
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Entity Type | Organization
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Legal Business Name | CENTERWELL SENIOR PRIMARY CARE (TN) PC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 7643 HIGHWAY 70 S
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City | NASHVILLE
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State | TN
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Zip | 37221-1706
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Country | US
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Telephone | 615-334-4635
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Fax | 615-234-4040
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 407-447-7120
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Fax |
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Authorized Official
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Title or Position | SENIOR CREDENTIALING PROFESSIONAL
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Name | ANGIE MARTINEZ
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Credential |
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Telephone | 407-447-7120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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