=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477280204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADINE O HOFMEISTER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2022
-----------------------------------------------------
Last Update Date | 08/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7575 COCKRILL BEND BLVD
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37209-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-350-4973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 BEDROCK DR
-----------------------------------------------------
City | WHITE HOUSE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37188-9564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-518-5368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 3594
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------