Provider Demographics
NPI:1205915311
Name:TRABALKA, MARY ELIZABETH (ANP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:TRABALKA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1839
Mailing Address - Country:US
Mailing Address - Phone:865-541-1975
Mailing Address - Fax:865-541-1976
Practice Address - Street 1:501 19TH ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1839
Practice Address - Country:US
Practice Address - Phone:865-541-1975
Practice Address - Fax:865-541-1976
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000084330363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3346293Medicaid
S59443Medicare UPIN
TN3346293Medicare ID - Type Unspecified