MEDICARE: MILLINGTON FAMILY MEDICINE, INC.

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1700227436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLINGTON FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	8510 WILKINSVILLE RD
Second Line	:	SUITE 104
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1537
Country	:	US
Telephone Number	:	901-872-3114
Fax Number	:	901-872-3116

Provider Business Practice Location Address
First Line	:	8510 WILKINSVILLE RD
Second Line	:	SUITE 104
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1537
Country	:	US
Telephone Number	:	901-872-3114
Fax Number	:	901-872-3116

Authorized Official
Title or Position	:	OWNER
Name	:	ROSEMARY JACOBS
Credential	:	MSN, APN-FNP-BC
Telephone Number	:	901-872-3114

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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