Provider Demographics
NPI:1306802855
Name:DETZEL, PATRICIA A (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:DETZEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:770-597-3069
Mailing Address - Fax:615-936-1106
Practice Address - Street 1:719 THOMPSON LN
Practice Address - Street 2:SUITE 27100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3609
Practice Address - Country:US
Practice Address - Phone:615-343-5700
Practice Address - Fax:615-343-8806
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166939367A00000X
TN15211367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA42BBBQBMedicare ID - Type Unspecified
GAQ06979Medicare UPIN