Provider Demographics
NPI:1891560165
Name:TANKSLEY MASK, ELISA CHRISTINE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:CHRISTINE
Last Name:TANKSLEY MASK
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:CHRISTINE
Other - Last Name:TANKSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:3334 LOVE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 21ST AVE S STE 4300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0014
Practice Address - Country:US
Practice Address - Phone:615-421-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty