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General NPI Number Information
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NPI Number | 1578274247
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Entity Type | Organization
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Legal Business Name | TN SKIN SUB LLC
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 118 16TH AVE S STE 4-277
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City | NASHVILLE
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State | TN
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Zip | 37203-3100
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Country | US
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Telephone | 480-389-6863
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Fax | 888-819-9648
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Provider Business Mailing Address
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Address Line | 118 16TH AVE S STE 4-277
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City | NASHVILLE
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State | TN
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Zip | 37203-3100
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Country | US
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Telephone | 480-389-6863
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Fax | 888-819-9648
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARVIS TZENG
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Credential | DO
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Telephone | 480-389-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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