Provider Demographics
NPI:1023589850
Name:MENDOZA, ILEANA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:ILEANA
Other - Middle Name:
Other - Last Name:TELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 ASH GROVE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6402
Mailing Address - Country:US
Mailing Address - Phone:615-364-2266
Mailing Address - Fax:
Practice Address - Street 1:4928 EDMONDSON PIKE STE 205
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4791
Practice Address - Country:US
Practice Address - Phone:615-222-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily