Provider Demographics
NPI:1265729925
Name:LASTOVKA, MARIA D (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:LASTOVKA
Suffix:
Gender:
Credentials:NP
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Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:768 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2556
Practice Address - Country:US
Practice Address - Phone:615-441-4400
Practice Address - Fax:615-441-4443
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2025-04-09
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Provider Licenses
StateLicense IDTaxonomies
TNAPN15909363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525572Medicaid