Healthcare Provider Details

I. General information

NPI: 1740202282
Provider Name (Legal Business Name): TRACI L. ELLIFF A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 CANTRELL RD #200
LITTLE ROCK AR
72223-1604
US

IV. Provider business mailing address

29 WEATHERWOOD DR
GREENBRIER AR
72058-8816
US

V. Phone/Fax

Practice location:
  • Phone: 501-581-1212
  • Fax: 501-712-1400
Mailing address:
  • Phone: 479-414-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA03361 ANP
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM01019
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: