Provider Demographics
NPI:1881127074
Name:PRENTICE, DESEREE (DO)
Entity type:Individual
Prefix:DR
First Name:DESEREE
Middle Name:
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-4029
Mailing Address - Fax:629-802-9993
Practice Address - Street 1:6130 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6813
Practice Address - Country:US
Practice Address - Phone:615-284-1450
Practice Address - Fax:629-208-2691
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN3535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program