Provider Demographics
NPI:1730692476
Name:MELICK, JENNIFER (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MELICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BLOMGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 COBBLER CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3963
Mailing Address - Country:US
Mailing Address - Phone:724-681-3019
Mailing Address - Fax:
Practice Address - Street 1:1531 HUNT CLUB BLVD STE 320
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6098
Practice Address - Country:US
Practice Address - Phone:615-452-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175504363LF0000X
TN30157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherMEDICARE PTAN