Basic Information
| Provider Information | |||||||||
| NPI: | 1396168019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLADKOWSKI | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 GREAT CIRCLE RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152227685 | ||||||||
| FaxNumber: | 6152227237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 N HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371302494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153966620 | ||||||||
| FaxNumber: | 6153966625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2014 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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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 | 163W00000X | 180907 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 18299 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | Q011185 | 05 | TN | MEDICAID |