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Individual
MICHAEL DAVID THACKER
Active
Individual
MICHAEL DAVID THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
00000193250
TN
363LF0000X
Family Nurse Practitioner
00241777354
VA
363LF0000X
Family Nurse Practitioner
Primary
25386
TN
Other
Enumeration date
04/12/2019
Last updated
05/05/2026
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