Provider Demographics
NPI:1770101958
Name:BORNEMAN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BORNEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 TENNESSEE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1222
Mailing Address - Country:US
Mailing Address - Phone:423-939-1500
Mailing Address - Fax:423-939-1503
Practice Address - Street 1:3742 TENNESSEE AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1222
Practice Address - Country:US
Practice Address - Phone:423-939-1500
Practice Address - Fax:423-939-1503
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000223655163W00000X
TN29840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse