Individual provider Active NPI

Michael Edgar Creazzo, FNP

  • Family Nurse Practitioner
  • Bristol, TN
National Provider Identifier
1538046248
Registry record updated Oct 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
39440 Issued in TN
Practice address
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone
(423) 844-1121
NPI assigned
Aug 18, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 39440 TN Primary

Addresses

Primary practice location

1 Medical Park Blvd
Bristol, TN 37620-7430

Mailing address

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251212003720 TN Practitioner - Nurse Practitioner 4284128521 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

1201 Bishop St
Union City, TN 38261-5403
Phone (731) 885-2410

Hospital & facility affiliations

  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
  • Smyth County Community Hospital Hospital, Marion, VA, CCN 490038
  • Lonesome Pine Hospital Hospital, Big Stone Gap, VA, CCN 490114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
39440TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC CurrentSince Dec 1, 2025 Accepting new patients

Locations

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760140800000",
    "number": "1538046248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-844-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-844-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREAZZO",
        "first_name": "MICHAEL",
        "middle_name": "EDGAR",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-10-11",
        "certification_date": "2025-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "39440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.