Provider Demographics
NPI:1992301923
Name:AMINOV, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:AMINOV
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 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:
Practice Address - Street 1:8913 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4206
Practice Address - Country:US
Practice Address - Phone:602-858-4361
Practice Address - Fax:602-858-4363
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242541363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty