Provider Demographics
NPI:1902404080
Name:TAUBENHEIM, TY (NP)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:TAUBENHEIM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:961 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8832
Practice Address - Country:US
Practice Address - Phone:865-690-4861
Practice Address - Fax:865-483-3807
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2024-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN28201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner