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General NPI Number Information
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NPI Number | 1508856873
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Entity Type | Individual
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Provider Name | GRETCHEN JILLIAN NITZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 919 E CENTRAL AVE STE 102
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City | LA FOLLETTE
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State | TN
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Zip | 37766-2778
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Country | US
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Telephone | 423-907-1740
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Fax | 423-907-1743
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Provider Business Mailing Address
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Address Line | 151 FRANK L DIGGS DR
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City | CLINTON
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State | TN
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Zip | 37716-6953
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Country | US
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Telephone | 865-647-3320
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Fax | 865-647-3329
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 119
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License Number State | TN
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