Provider Demographics
NPI:1740202282
Name:ELLIFF, TRACI L (APRN)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:L
Last Name:ELLIFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-8816
Mailing Address - Country:US
Mailing Address - Phone:479-414-8089
Mailing Address - Fax:
Practice Address - Street 1:12600 CANTRELL RD
Practice Address - Street 2:#200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1604
Practice Address - Country:US
Practice Address - Phone:501-581-1212
Practice Address - Fax:501-712-1400
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM01019367A00000X
ARA03361 ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154125799Medicaid