=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801201926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE ELLERT ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2014
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 549 E UNION ST
-----------------------------------------------------
City | GLEASON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38229-7209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-333-0957
-----------------------------------------------------
Fax | 833-764-4567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 FAIRVIEW CHURCH RD
-----------------------------------------------------
City | HUNTINGDON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38344-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-473-7545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APN0000024129
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2166292
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------