Healthcare Provider Details

I. General information

NPI: 1376994657
Provider Name (Legal Business Name): NEW HORIZON DIABETES CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 HARDING PL ST 102
NASHVILLE TN
37211-3998
US

IV. Provider business mailing address

390 HARDING PL ST 102
NASHVILLE TN
37211-3998
US

V. Phone/Fax

Practice location:
  • Phone: 615-840-7994
  • Fax: 615-739-6678
Mailing address:
  • Phone: 615-840-7994
  • Fax: 615-739-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number17240
License Number StateTN

VIII. Authorized Official

Name: DR. LUISA FERNANDA LEAL
Title or Position: DOCTOR OF NURSING PRACTICE
Credential: DNP, MSN, MBA, ANPBC
Phone: 615-840-7994