Individual
TARA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4555 TROUSDALE DR, NASHVILLE, TN 37204-4585
(615) 781-3000
Mailing address
5118 ANDER DR, BRENTWOOD, TN 37027-8872
(401) 359-6194
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/09/2025
Last updated
04/09/2025
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