Provider Demographics
NPI:1114445954
Name:DELGADO, ABRI-RONEL
Entity Type:Individual
Prefix:
First Name:ABRI-RONEL
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABRI-RONEL
Other - Middle Name:
Other - Last Name:OBERHOLSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7405 SHALLOWFORD RD STE 270
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2662
Mailing Address - Country:US
Mailing Address - Phone:423-602-9545
Mailing Address - Fax:423-602-9546
Practice Address - Street 1:7405 SHALLOWFORD RD STE 270
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2662
Practice Address - Country:US
Practice Address - Phone:423-602-9545
Practice Address - Fax:422-602-9546
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN158440OtherDEPARTMENT OF HEALTH
TN23124OtherDEPARTMENT OF HEALTH