Provider Demographics
NPI:1992933329
Name:TRIBBLE, ELISHA A (ARNP)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:A
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TROON WAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2910
Mailing Address - Country:US
Mailing Address - Phone:478-361-2195
Mailing Address - Fax:
Practice Address - Street 1:400 CHARTER BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4831
Practice Address - Country:US
Practice Address - Phone:478-757-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171306363LF0000X
GAPENDING363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily