Healthcare Provider Details

I. General information

NPI: 1669123493
Provider Name (Legal Business Name): SABRINA CARMICKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST AVE S
NASHVILLE TN
37212-3160
US

IV. Provider business mailing address

2006 BROADWAY APT 207
NASHVILLE TN
37203-2431
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-0265
  • Fax:
Mailing address:
  • Phone: 317-246-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: