Provider Demographics
NPI:1386763977
Name:MULLINS, TANYA A (PAC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:A
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:A
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:125 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6474
Mailing Address - Country:US
Mailing Address - Phone:615-771-8552
Mailing Address - Fax:615-771-8520
Practice Address - Street 1:125 COOL SPRINGS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6474
Practice Address - Country:US
Practice Address - Phone:615-771-8552
Practice Address - Fax:615-771-8520
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN710363A00000X
TNPA0000000710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370244Medicare PIN
TN3665821Medicare UPIN