Healthcare Provider Details

I. General information

NPI: 1023751708
Provider Name (Legal Business Name): TAVIA ISAURA GONZALEZ PENA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONECREST BLVD STE 310
SMYRNA TN
37167-6801
US

IV. Provider business mailing address

810 MORROW RD
NASHVILLE TN
37209-1929
US

V. Phone/Fax

Practice location:
  • Phone: 629-206-6858
  • Fax:
Mailing address:
  • Phone: 214-934-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number77444
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: