Healthcare Provider Details

I. General information

NPI: 1497288856
Provider Name (Legal Business Name): HEATHER ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CHILDRENS WAY STE 2521
NASHVILLE TN
37232
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 615-875-3367
  • Fax:
Mailing address:
  • Phone: 615-936-2000
  • Fax: 615-936-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1-108586
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number24388
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: