Lastovka, Maria D.

Lastovka, Maria D. is an individual health care provider with primary practice located at 127 Crestview Park Dr Suite 205, Dickson TN 37055-2855. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Lastovka, Maria D. can be contacted via phone (615) 441-4562.

Contact Information

Primary practice address
127 Crestview Park Dr Suite 205 Dickson TN 37055-2855
Phone: (615) 441-4562
Fax: (615) 446-1357
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X APN15909 Tennessee

Profile Details

NPI number 1265729925
LBN Legal business name Lastovka, Maria D.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 1st, 2011
Last updated Jan 28th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265729925 NPPES
Tennessee MEDICAID 1525572

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