Provider Demographics
NPI:1174751671
Name:TRAIL, LISA NICOLE (ANP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:TRAIL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NICOLE
Other - Last Name:GARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-2487
Mailing Address - Country:US
Mailing Address - Phone:615-896-6996
Mailing Address - Fax:615-896-6985
Practice Address - Street 1:1115B DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2487
Practice Address - Country:US
Practice Address - Phone:615-896-6996
Practice Address - Fax:615-896-6985
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14229363LA2200X
TNAPN14229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health