Provider Demographics
NPI:1144273061
Name:TODD, PAULA (FNP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-0024
Mailing Address - Country:US
Mailing Address - Phone:615-962-3675
Mailing Address - Fax:615-246-4294
Practice Address - Street 1:530 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1622
Practice Address - Country:US
Practice Address - Phone:615-962-3675
Practice Address - Fax:615-246-4294
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621852954OtherTAX ID
TN4134877OtherBLUE CROSS BLUE SHIELD TN
TN3643017Medicaid
TN621852954OtherTAX ID
TN3643017Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER