Individual
MRS. CONNIE M TATGENHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1924 ALCOA HWY # U67, KNOXVILLE, TN 37920-1511
(865) 305-9350
(865) 305-8681
Mailing address
1924 ALCOA HWY # U67, KNOXVILLE, TN 37920-1511
(865) 305-9350
(865) 305-8681
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12263
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I506189
MEDICARE INDIVIDUAL PTAN
TN
01
—
1689631137
GROUP NPI
TN
05
—
3044823
—
TN
01
—
3373352
MEDICARE LEGACY GROUP
TN
01
—
3706633
MEDICARE LEGACY GROUP
TN
Enumeration date
09/28/2006
Last updated
09/28/2012
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