Provider Demographics
NPI:1053591685
Name:HETTRICK, JOSHUA A
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:HETTRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 METROPLEX DR
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:446 METROPLEX DR
Practice Address - Street 2:SUITE A-100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3139
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955OtherMEDICARE GROUP NUMBER