Healthcare Provider Details

I. General information

NPI: 1063737278
Provider Name (Legal Business Name): ELIZABETH ANN KOUVARAKIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 TRIANGLE FARM RD
CHATTANOOGA TN
37421-2874
US

IV. Provider business mailing address

2571 TRIANGLE FARM RD
CHATTANOOGA TN
37421-2874
US

V. Phone/Fax

Practice location:
  • Phone: 423-322-8190
  • Fax:
Mailing address:
  • Phone: 423-322-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number15208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: