Provider Demographics
NPI:1689220154
Name:ELDRIDGE, JOAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 HIGHWAY 72 W STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9564
Mailing Address - Country:US
Mailing Address - Phone:256-837-2271
Mailing Address - Fax:256-837-2910
Practice Address - Street 1:8045 HIGHWAY 72 W STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9564
Practice Address - Country:US
Practice Address - Phone:256-837-2271
Practice Address - Fax:256-837-2910
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-133344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty