Provider Demographics
NPI:1124021001
Name:YOUNGBLOOD, ELIZABETH A (RN, APN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440222
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0222
Mailing Address - Country:US
Mailing Address - Phone:615-373-1255
Mailing Address - Fax:615-371-9040
Practice Address - Street 1:343 FRANKLIN RD
Practice Address - Street 2:STE 108
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5250
Practice Address - Country:US
Practice Address - Phone:615-373-1255
Practice Address - Fax:615-371-9040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse