Provider Demographics
NPI:1285297648
Name:NEZIFORT, ADELINE (APRN)
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:
Last Name:NEZIFORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ADELINE
Other - Middle Name:
Other - Last Name:NEZIFORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3718 ROUND ROCK CV APT 308
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4061
Mailing Address - Country:US
Mailing Address - Phone:561-563-9565
Mailing Address - Fax:
Practice Address - Street 1:3718 ROUND ROCK CV APT 308
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4061
Practice Address - Country:US
Practice Address - Phone:561-563-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000883363LF0000X
TN00000256686363LF0000X
TNAPN0000025668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11000883OtherBOARD OF NURSING
TN0000025668OtherADVANCED PRACTICE REGISTERED NURSE