Healthcare Provider Details

I. General information

NPI: 1639906357
Provider Name (Legal Business Name): NICOLAS PEREZ LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 JESS NEELY DR
NASHVILLE TN
37212-2039
US

IV. Provider business mailing address

525 BAXTER LN
NASHVILLE TN
37220-2201
US

V. Phone/Fax

Practice location:
  • Phone: 561-284-7410
  • Fax:
Mailing address:
  • Phone: 561-284-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3498
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: