Provider Demographics
NPI:1972930733
Name:BORNEMANN, ERIC (RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BORNEMANN
Suffix:
Gender:M
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WALNUT ST
Mailing Address - Street 2:APT. 205
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1134
Mailing Address - Country:US
Mailing Address - Phone:617-279-9202
Mailing Address - Fax:
Practice Address - Street 1:1318 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2336
Practice Address - Country:US
Practice Address - Phone:931-598-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17935363LP0200X
MARN2281187363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics