Provider Demographics
NPI:1326224809
Name:DESANTIS, DINO ANTHONY (ACNP-BC)
Entity type:Individual
Prefix:
First Name:DINO
Middle Name:ANTHONY
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 24TH AVE S
Mailing Address - Street 2:VA TENNESSEE VALLEY HEALTHCARE SYSTEM
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2637
Mailing Address - Country:US
Mailing Address - Phone:615-873-7512
Mailing Address - Fax:615-873-7757
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:VA TENNESSEE VALLEY HEALTHCARE SYSTEM
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-873-7512
Practice Address - Fax:615-873-7757
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6075P363L00000X
TN13167363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000028412QOtherHUMANA
KY000000622722OtherANTHEM
IN200966480Medicaid
KY3744147000OtherPASSPORT ADVANTAGE
KY9038116OtherCIGNA
KY7100088140Medicaid
KY106553OtherSIHO
KY50026174OtherPASSPORT
KY50026174OtherPASSPORT