Provider Demographics
NPI:1528509825
Name:GOODMAN, LANA BETH (ARNP)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:BETH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:BETH
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2358 LIFESTYLE WAY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2291
Mailing Address - Country:US
Mailing Address - Phone:423-521-1100
Mailing Address - Fax:423-521-1200
Practice Address - Street 1:2358 LIFESTYLE WAY
Practice Address - Street 2:SUITE 212
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2291
Practice Address - Country:US
Practice Address - Phone:423-521-1100
Practice Address - Fax:423-521-1200
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22356207N00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily