Provider Demographics
NPI:1366420481
Name:COUILLARD, ELIZABETH ANN (CRNA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:COUILLARD
Suffix:
Gender:F
Credentials:CRNA
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 3090
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-3090
Mailing Address - Country:US
Mailing Address - Phone:423-472-6513
Mailing Address - Fax:423-476-2062
Practice Address - Street 1:2080 CHAMBLISS AVE NW
Practice Address - Street 2:CLEVELAND ANESTHESIOLOGISTS INC
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3894
Practice Address - Country:US
Practice Address - Phone:423-472-6514
Practice Address - Fax:423-476-2062
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 9275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
3608733Medicare ID - Type Unspecified