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General NPI Number Information
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NPI Number | 1326934415
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Entity Type | Individual
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Provider Name | JOHN PARK
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Gender | Male
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 461 21ST AVE S
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City | NASHVILLE
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State | TN
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Zip | 37240-1104
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Country | US
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Telephone | 615-322-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 8434 RED EAGLE CT
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City | LORTON
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State | VA
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Zip | 22079-3048
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AC008499
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License Number State | MD
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