Healthcare Provider Details

I. General information

NPI: 1326956889
Provider Name (Legal Business Name): EMILY JO BOMMARITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MELROSE AVE
NASHVILLE TN
37211-2161
US

IV. Provider business mailing address

7860 HALEWOOD DR
COLLEGE GROVE TN
37046-2053
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-8955
  • Fax:
Mailing address:
  • Phone: 949-633-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: