Provider Demographics
NPI:1548058324
Name:GREEN, ZOIE (PA-C)
Entity type:Individual
Prefix:
First Name:ZOIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HAGAN ST APT 345
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6574
Mailing Address - Country:US
Mailing Address - Phone:423-557-2956
Mailing Address - Fax:
Practice Address - Street 1:105 CHESTNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-7457
Practice Address - Country:US
Practice Address - Phone:423-557-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant