MEDICARE: MISS ADRIANNA MARIA CANNONE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5383	TN

General Provider Information

NPI Number	:	1124733050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ADRIANNA MARIA CANNONE PA-C

Provider Business Mailing Address
First Line	:	40 W CALDWELL ST STE 100
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3180
Country	:	US
Telephone Number	:	615-773-2712
Fax Number	:	615-773-2707

Provider Business Practice Location Address
First Line	:	40 W CALDWELL ST STE 100
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3180
Country	:	US
Telephone Number	:	615-773-2712
Fax Number	:	615-773-2707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	10/01/2025

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