Provider Demographics
NPI:1235630112
Name:ESTOCK, ELIZABETH AMELIA (NP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMELIA
Last Name:ESTOCK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:AMELIA
Other - Last Name:RALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4815 E LONGDALE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4413
Mailing Address - Country:US
Mailing Address - Phone:615-305-9964
Mailing Address - Fax:
Practice Address - Street 1:1021 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058
Practice Address - Country:US
Practice Address - Phone:931-232-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000181887163W00000X
TN0000023336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse