Healthcare Provider Details

I. General information

NPI: 1922915016
Provider Name (Legal Business Name): NICHOLAS MICHAEL DIBISCEGLIE PHARMD, MMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N JACKSON ST
TULLAHOMA TN
37388-2201
US

IV. Provider business mailing address

345 STURDEE CIR
SMYRNA TN
37167-2281
US

V. Phone/Fax

Practice location:
  • Phone: 931-393-3000
  • Fax:
Mailing address:
  • Phone: 615-322-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number48052
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: