Provider Demographics
NPI:1528250123
Name:MOSS, COLLEEN REILLY (NNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:REILLY
Last Name:MOSS
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:FRANCES
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:2200 CHILDRENS WAY # 2521
Practice Address - Street 2:NEONATAL NURSE PRACTITIONERS
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-9750
Practice Address - Country:US
Practice Address - Phone:615-322-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028942363LN0000X
TNAPN12603363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal