Provider Demographics
NPI:1285682906
Name:ELLER, BARBARA AILEEN (CNNP)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:AILEEN
Last Name:ELLER
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9234 COBBLESTONE HILL DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8942
Mailing Address - Country:US
Mailing Address - Phone:423-855-5678
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:PEDIATRIX MEDICAL GROUP OF TENNESSEE
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-778-6172
Practice Address - Fax:423-778-6938
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000010906363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal