Provider Demographics
NPI:1518970649
Name:TRENT-METZ, ELIZABETH A (MSN RNCS FNP 106155)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:TRENT-METZ
Suffix:
Gender:F
Credentials:MSN RNCS FNP 106155
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-272-7651
Mailing Address - Fax:423-272-6177
Practice Address - Street 1:116 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3247
Practice Address - Country:US
Practice Address - Phone:423-272-7651
Practice Address - Fax:423-272-6177
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPRN7216363L00000X
TNRN106155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729687Medicaid
4045020OtherMAGELLAN PINNACLE
4045020OtherMAGELLAN NAVIGATOR
4045020OtherMAGELLAN SUMMIT
620582605OtherTRICARE SOUTH
334969OtherVALUE OPTIONS GROUP
351654200OtherDOL WORKERS COMP
620582605OtherTHREE RIVERS PROVI
620582605Y7OtherUBH JOHN DEERE
TN3908734Medicaid
620582605OtherMENTAL HEALTH NETW
620582605OtherPHCS
2246806OtherCIGNA MCC
620582605OtherINITIAL GROUP
7884520OtherAETNA
TN3908734Medicare ID - Type UnspecifiedGROUP
4045020OtherMAGELLAN PINNACLE
TN3729687Medicaid