=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710713664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOPE GAVIGAN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2024
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 PATTERSON ST STE 502
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-6511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-342-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4808 HIGHWAY 31 W
-----------------------------------------------------
City | COTTONTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37048-4854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-980-0669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 37036
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------