Healthcare Provider Details

I. General information

NPI: 1881219178
Provider Name (Legal Business Name): CHRISTINA TRAN ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MEMORIAL CT
JACKSONVILLE NC
28546-6322
US

IV. Provider business mailing address

PO BOX 986513 DEPARTMENT 100
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-3200
  • Fax: 910-353-0600
Mailing address:
  • Phone: 910-219-8326
  • Fax: 910-939-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013191
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5013191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: