Provider Demographics
NPI:1649603135
Name:WILDER, ELIZABETH ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WILDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:140 VO TECH DR.
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-8003
Mailing Address - Country:US
Mailing Address - Phone:931-474-8888
Mailing Address - Fax:931-474-8889
Practice Address - Street 1:140 VO TECH DR.
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1390
Practice Address - Country:US
Practice Address - Phone:931-474-8888
Practice Address - Fax:931-474-8889
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily