Provider Demographics
NPI:1215949326
Name:CORNAVACA, SPRING ELAINE (CRNA)
Entity type:Individual
Prefix:
First Name:SPRING
Middle Name:ELAINE
Last Name:CORNAVACA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SPRING
Other - Middle Name:ELAINE
Other - Last Name:WILDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E. THIRD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169392163W00000X, 367500000X
TNRN124955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4156966OtherBLUE CROSS BLUE SHIELD OF TN
P00430484OtherRAILROAD MEDICARE
GAN356383OtherWELLCARE (GA MEDICAID)
AL009911539Medicaid
NC8052759Medicaid
TN3638075Medicaid
GA453654394AMedicaid
P00430484OtherRAILROAD MEDICARE