MEDICARE: EDWARD ELLIOTT III III APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	174618	TN
2	363LF0000X	Family Nurse Practitioner	21661	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6077736	OTHER	TN	BCBS TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518412105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD ELLIOTT III III APN

Provider Business Mailing Address
First Line	:	9039 TARRINGTON LN
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37069-8413
Country	:	US
Telephone Number	:	615-948-7835
Fax Number	:

Provider Business Practice Location Address
First Line	:	9039 TARRINGTON LN
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37069-8413
Country	:	US
Telephone Number	:	615-948-7835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	02/21/2026

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