Healthcare Provider Details

I. General information

NPI: 1992616783
Provider Name (Legal Business Name): IVY SKIN STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LIBERTY PIKE STE 1000
FRANKLIN TN
37067-8636
US

IV. Provider business mailing address

1400 LIBERTY PIKE STE 1000
FRANKLIN TN
37067-8636
US

V. Phone/Fax

Practice location:
  • Phone: 615-471-8525
  • Fax:
Mailing address:
  • Phone: 615-471-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IVY PROTHRO
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 305-302-1514