Provider Demographics
NPI:1043922933
Name:KRUSE, ELISSA MAE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:MAE
Last Name:KRUSE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ROSA L PARKS BLVD APT 220
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2571
Mailing Address - Country:US
Mailing Address - Phone:615-587-9590
Mailing Address - Fax:
Practice Address - Street 1:1400 ROSA PARKS BLVD.
Practice Address - Street 2:#220
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2132
Practice Address - Country:US
Practice Address - Phone:615-587-9590
Practice Address - Fax:615-941-8507
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily