Healthcare Provider Details

I. General information

NPI: 1659839637
Provider Name (Legal Business Name): TARSHA ELLIOTT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 POPLAR AVE STE 100
MEMPHIS TN
38112-3246
US

IV. Provider business mailing address

11252 IVY DR
ARLINGTON TN
38002-4154
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-3018
  • Fax: 901-725-3030
Mailing address:
  • Phone: 901-508-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25421
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: