Healthcare Provider Details

I. General information

NPI: 1003735283
Provider Name (Legal Business Name): ELIZABETH ROTH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 WESTGATE CIR STE 200
BRENTWOOD TN
37027-8077
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 615-376-8195
  • Fax: 833-464-2712
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42416
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: