Provider Demographics
NPI:1174779375
Name:PEREZ, JACLYN M (FNP-C)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP-C
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Other - Credentials:
Mailing Address - Street 1:515 STONECREST PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-625-7112
Mailing Address - Fax:615-625-7028
Practice Address - Street 1:800 WEATHERLY DR
Practice Address - Street 2:STE 201
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8957
Practice Address - Country:US
Practice Address - Phone:931-648-1912
Practice Address - Fax:931-648-1277
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2013-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN13518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I500281Medicare PIN