Provider Demographics
NPI:1053382648
Name:HYDRICK, JACK DEMPSEY II (FNP)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:DEMPSEY
Last Name:HYDRICK
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 SOUTH CHURCH ST
Mailing Address - Street 2:STE B
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127
Mailing Address - Country:US
Mailing Address - Phone:615-895-3600
Mailing Address - Fax:615-895-0024
Practice Address - Street 1:2910 SOUTH CHURCH ST
Practice Address - Street 2:STE B
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127
Practice Address - Country:US
Practice Address - Phone:615-895-3600
Practice Address - Fax:615-895-0024
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4095318OtherBCBS
TN3907988Medicaid
TN3907983Medicare ID - Type Unspecified
P10201Medicare UPIN