Provider Demographics
NPI:1912763368
Name:REBARCHAK, DOROTHEA GRACE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:GRACE
Last Name:REBARCHAK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 PARTHENON AVE APT 100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1493
Mailing Address - Country:US
Mailing Address - Phone:251-402-1764
Mailing Address - Fax:
Practice Address - Street 1:3147 PARTHENON AVE APT 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1493
Practice Address - Country:US
Practice Address - Phone:251-402-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35882363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health