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Individual

ELIZABETH ILLENBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
600 N JACKSON ST, TULLAHOMA, TN 37388-3542
(931) 563-5469
Mailing address
151 EDNA W GROOMS LN, WATERTOWN, TN 37184-1078

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
22622
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
22622
TN

Other

Enumeration date
05/23/2017
Last updated
02/24/2025
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