Healthcare Provider Details

I. General information

NPI: 1821002031
Provider Name (Legal Business Name): DR. CAROL LYNN CISTOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 MURFREESBORO PIKE
NASHVILLE TN
37217-3505
US

IV. Provider business mailing address

2410 FRANKLIN PIKE
NASHVILLE TN
37204-2227
US

V. Phone/Fax

Practice location:
  • Phone: 615-292-9770
  • Fax: 615-964-6951
Mailing address:
  • Phone: 615-983-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0000024871
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: