Basic Information
| Provider Information | |||||||||
| NPI: | 1265960751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEDIN-MOSCHOVAS | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | DNP, ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2016 GREYSTONE SQ | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383053575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316641773 | ||||||||
| FaxNumber: | 7316641751 | ||||||||
| Practice Location | |||||||||
| Address1: | 2016 GREYSTONE SQ | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383053575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316641773 | ||||||||
| FaxNumber: | 7316641751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN0000019721 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | APN0000019721 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.