Provider Demographics
NPI:1285937250
Name:MOREA, JAN SUMMER MICHELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JAN SUMMER
Middle Name:MICHELLE
Last Name:MOREA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JAN SUMMER
Other - Middle Name:MICHELLE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 N STATE OF FRANKLIN RD STE 135
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6972
Mailing Address - Country:US
Mailing Address - Phone:423-431-2350
Mailing Address - Fax:423-431-2372
Practice Address - Street 1:410 N STATE OF FRANKLIN RD STE 135
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6972
Practice Address - Country:US
Practice Address - Phone:423-431-2350
Practice Address - Fax:423-431-2372
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144878163W00000X
NC5009273363LF0000X
TN15771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I500516Medicare PIN