Provider Demographics
NPI:1295231512
Name:HOGAN, ELAINA CUBINE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINA
Middle Name:CUBINE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 HWY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053
Mailing Address - Country:US
Mailing Address - Phone:901-873-4242
Mailing Address - Fax:901-873-4269
Practice Address - Street 1:PRIMARY CARE PEDIATRICS
Practice Address - Street 2:8222 HWY 51 N
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053
Practice Address - Country:US
Practice Address - Phone:901-873-4242
Practice Address - Fax:901-873-4269
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN023831363LP0200X
TN23831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ035883Medicaid