Provider Demographics
NPI:1427455138
Name:TLC II PRIMARY CARE PLLC
Entity type:Organization
Organization Name:TLC II PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-362-7600
Mailing Address - Street 1:9457 DAVID SMITH LANE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7292
Mailing Address - Country:US
Mailing Address - Phone:423-362-7600
Mailing Address - Fax:
Practice Address - Street 1:9457 DAVID SMITH LN
Practice Address - Street 2:SUITE 105
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7292
Practice Address - Country:US
Practice Address - Phone:423-362-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN00000051112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty