Provider Demographics
NPI:1053350074
Name:JOSE, LINDA G (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:G
Last Name:JOSE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 TOMAHAWK TRCE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6501
Mailing Address - Country:US
Mailing Address - Phone:615-294-7766
Mailing Address - Fax:615-225-8617
Practice Address - Street 1:1927 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1545
Practice Address - Country:US
Practice Address - Phone:615-294-7766
Practice Address - Fax:615-225-8617
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 11631363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicare ID - Type Unspecified