Provider Demographics
NPI:1194069948
Name:JARRELL, LEAH SUZANNE (FNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SUZANNE
Last Name:JARRELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:SUZANNE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5602 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8746
Mailing Address - Country:US
Mailing Address - Phone:423-785-7311
Mailing Address - Fax:
Practice Address - Street 1:5602 HUNTER RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8746
Practice Address - Country:US
Practice Address - Phone:423-785-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112452363LP2300X
TNAPN0000012736363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care