Individual
JACOB BRADLEY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNAP
Contact information
Practice address
315 HOSPITAL DR, MADISON, TN 37115-5030
(615) 732-7662
Mailing address
315 HOSPITAL DR, MADISON, TN 37115-5030
(615) 732-7662
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
267408
TN
367500000X
Certified Registered Nurse Anesthetist
4051451
KY
Other
Enumeration date
11/11/2022
Last updated
01/07/2026
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