Provider Demographics
NPI:1558135095
Name:THAMIZHARASAN, NIVEDITA (APN)
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:
Last Name:THAMIZHARASAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 5TH AVE N APT 454
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2879
Mailing Address - Country:US
Mailing Address - Phone:901-601-5555
Mailing Address - Fax:
Practice Address - Street 1:1335 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6108
Practice Address - Country:US
Practice Address - Phone:615-459-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34944363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics