Provider Demographics
NPI:1023171576
Name:WOLFF, BARBARA ELAYNE (PAC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELAYNE
Last Name:WOLFF
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1172
Mailing Address - Country:US
Mailing Address - Phone:615-449-5771
Mailing Address - Fax:615-449-5740
Practice Address - Street 1:107 GLIDEPATH WAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4133
Practice Address - Country:US
Practice Address - Phone:615-449-5771
Practice Address - Fax:615-449-5740
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA 832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3671645Medicare ID - Type Unspecified