Provider Demographics
NPI:1639811607
Name:ELCAN, CAROLINE MCMURTRY
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MCMURTRY
Last Name:ELCAN
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 1:739 PRESIDENT PL STE 110
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6845
Mailing Address - Country:US
Mailing Address - Phone:615-625-7780
Mailing Address - Fax:615-625-7781
Practice Address - Street 1:739 PRESIDENT PL STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6845
Practice Address - Country:US
Practice Address - Phone:615-625-7780
Practice Address - Fax:615-625-7781
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28364363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN28364OtherAPN LICENSE