Provider Demographics
NPI:1902328362
Name:ROACH, TERRI BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:BROOKE
Last Name:ROACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 OAK TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5420
Mailing Address - Country:US
Mailing Address - Phone:615-512-8133
Mailing Address - Fax:
Practice Address - Street 1:720 COOL SPRINGS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7259
Practice Address - Country:US
Practice Address - Phone:615-257-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000127177163W00000X
TNAPN0000021331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse