Basic Information
| Provider Information | |||||||||
| NPI: | 1992306609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLINTOCK | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 HAYES ST | ||||||||
| Address2: | STE 800 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153290570 | ||||||||
| FaxNumber: | 6153290579 | ||||||||
| Practice Location | |||||||||
| Address1: | 5653 FRIST BLVD STE 434 | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158719996 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2020 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1003083 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 30217 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1003083 | 01 | TX | APRN-CNP | OTHER | F05200486 | 01 | AMERICAN ACADEMY OF NURSE PRACTITIONERS | OTHER |