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General NPI Number Information
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NPI Number | 1427455138
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Entity Type | Organization
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Legal Business Name | TLC II PRIMARY CARE PLLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 9457 DAVID SMITH LN SUITE 105
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City | OOLTEWAH
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State | TN
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Zip | 37363-7292
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Country | US
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Telephone | 423-362-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 9457 DAVID SMITH LANE SUITE 105
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City | OOLTEWAH
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State | TN
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Zip | 37363-7292
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Country | US
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Telephone | 423-362-7600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBYN L SANDIN
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Credential | MD
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Telephone | 423-362-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN00000051112
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License Number State | TN
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