Provider Demographics
NPI:1619294675
Name:HIBBS RAMAN, BROOK CHAREE
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:CHAREE
Last Name:HIBBS RAMAN
Suffix:
Gender:F
Credentials:
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 3549
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-0549
Mailing Address - Country:US
Mailing Address - Phone:423-698-3309
Mailing Address - Fax:423-624-6355
Practice Address - Street 1:410 N CEDAR BLUFF RD
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3623
Practice Address - Country:US
Practice Address - Phone:865-342-9011
Practice Address - Fax:865-691-0843
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN156334367500000X
TNAPN15045367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00878809OtherRAILROAD MEDICARE
TN4267478OtherBLUE CROSS BLUE SHIELD OF TN
TN1521470Medicaid
TNI38438Medicare PIN