Provider Demographics
NPI:1659839637
Name:ELLIOTT, TARSHA (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:TARSHA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11252 IVY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4154
Mailing Address - Country:US
Mailing Address - Phone:901-508-2928
Mailing Address - Fax:
Practice Address - Street 1:2430 POPLAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3246
Practice Address - Country:US
Practice Address - Phone:901-725-3018
Practice Address - Fax:901-725-3030
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily