Provider Demographics
NPI:1093025751
Name:ZANA ELLIOT ENTERPRISES LLC
Entity Type:Organization
Organization Name:ZANA ELLIOT ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:903-941-0786
Mailing Address - Street 1:12751 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704
Mailing Address - Country:US
Mailing Address - Phone:903-941-0786
Mailing Address - Fax:903-881-5145
Practice Address - Street 1:12751 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704
Practice Address - Country:US
Practice Address - Phone:903-941-0786
Practice Address - Fax:903-881-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty