Provider Demographics
NPI:1871953158
Name:HENDERLIGHT, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HENDERLIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291044
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1044
Mailing Address - Country:US
Mailing Address - Phone:615-922-8898
Mailing Address - Fax:
Practice Address - Street 1:555 MARRIOTT DR
Practice Address - Street 2:STE 315
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-5020
Practice Address - Country:US
Practice Address - Phone:615-922-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X, 146M00000X
TN146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate