Healthcare Provider Details

I. General information

NPI: 1235510934
Provider Name (Legal Business Name): TALISA'S HAIR CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 10TH AVE N STE 117
NASHVILLE TN
37203-3458
US

IV. Provider business mailing address

315 10TH AVE N STE 117
NASHVILLE TN
37203-3458
US

V. Phone/Fax

Practice location:
  • Phone: 817-513-8967
  • Fax:
Mailing address:
  • Phone: 817-513-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number71360
License Number StateTN

VIII. Authorized Official

Name: MRS. TALISA BLACKMAN
Title or Position: OWNER/STYLIST
Credential:
Phone: 817-513-8967