Provider Demographics
NPI:1437192358
Name:BROCK, ELIZABETH T (N,P)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:BROCK
Suffix:
Gender:F
Credentials:N,P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 PARKWEST BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4303
Mailing Address - Country:US
Mailing Address - Phone:865-531-5878
Mailing Address - Fax:865-531-7690
Practice Address - Street 1:9314 PARKWEST BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4303
Practice Address - Country:US
Practice Address - Phone:865-531-5878
Practice Address - Fax:865-531-7690
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05451363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3345780Medicare ID - Type Unspecified
TNS54506Medicare UPIN