Provider Demographics
NPI:1538848437
Name:PATE, TARA (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:PATE
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 1:5505 CREEKWOOD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-1201
Mailing Address - Country:US
Mailing Address - Phone:865-986-1400
Mailing Address - Fax:865-986-9400
Practice Address - Street 1:5505 CREEKWOOD PARK BLVD
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-1201
Practice Address - Country:US
Practice Address - Phone:865-986-1400
Practice Address - Fax:865-986-9400
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily