MEDICARE: ANGELA CHURCH FNP

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	26515	TN

General Provider Information

NPI Number	:	1982235735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CHURCH FNP

Provider Business Mailing Address
First Line	:	1665 BONNIE LN
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-494-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 BONNIE LN STE 101
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-531-8555
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	03/20/2020

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