Provider Demographics
NPI:1821002031
Name:CISTOLA, CAROL LYNN
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:CISTOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 FRANKLIN PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2227
Mailing Address - Country:US
Mailing Address - Phone:615-983-8247
Mailing Address - Fax:
Practice Address - Street 1:2637 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3505
Practice Address - Country:US
Practice Address - Phone:615-292-9770
Practice Address - Fax:615-964-6951
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3097556Medicaid
TN4119515Medicaid
TN3097556Medicaid
TNC97040Medicare UPIN