Provider Demographics
NPI:1104504661
Name:STREET, FRANNA NICOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:FRANNA
Middle Name:NICOLE
Last Name:STREET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:FRANNA
Other - Middle Name:NICOLE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1185 W MOUNTAIN VIEW RD APT 1318
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2530
Mailing Address - Country:US
Mailing Address - Phone:423-767-4940
Mailing Address - Fax:
Practice Address - Street 1:LAMONT ST & VETERANS WAY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN245410163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse