Healthcare Provider Details

I. General information

NPI: 1528766797
Provider Name (Legal Business Name): EVA MARIE COLEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 COURAGE WAY
CHATTANOOGA TN
37421-1555
US

IV. Provider business mailing address

7345 COURAGE WAY
CHATTANOOGA TN
37421-1555
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-9797
  • Fax: 423-602-9796
Mailing address:
  • Phone: 423-602-9797
  • Fax: 423-602-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number00002121199
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number33831
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: