Provider Demographics
NPI:1689358830
Name:ETON, MITCHELL (FNP)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:ETON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 WEEPING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-1738
Mailing Address - Country:US
Mailing Address - Phone:813-454-8305
Mailing Address - Fax:
Practice Address - Street 1:2339 MCCALLIE AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3209
Practice Address - Country:US
Practice Address - Phone:423-698-2435
Practice Address - Fax:423-697-6173
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily