Provider Demographics
NPI:1699264440
Name:QUATTLEBAUM, ADDI LAUREN (FNP-BC)
Entity type:Individual
Prefix:
First Name:ADDI
Middle Name:LAUREN
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ADDI
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:615-346-8468
Mailing Address - Fax:855-737-5542
Practice Address - Street 1:333 COMMERCE ST STE 700
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37201-1835
Practice Address - Country:US
Practice Address - Phone:615-346-8468
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036237Medicaid