Basic Information
| Provider Information | |||||||||
| NPI: | 1730465089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUENECHEA | ||||||||
| FirstName: | AMAYA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24730 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372024730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152221900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5201 CHARLOTTE PIKE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372093320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152221900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2011 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
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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 | 165696 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 16206 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4312254 | 01 | TN | BCBST | OTHER | 1526393 | 05 | TN | MEDICAID |