# MR. JASON ENGHOLM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1528540812
- **Gender:** Man
- **Credential:** FNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WE0003X | Emergency Registered Nurse | 168920 | TN | — |
| 363L00000X | Nurse Practitioner | 24887 | TN | Yes |

## Other

- **Enumeration date:** 09/03/2018
- **Last updated:** 04/03/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 168920 | RN LISCENSE | TN |
| 01 | — | 24887 | APRN LICENSE | TN |