Provider Demographics
NPI:1053894121
Name:ELDER, TAJA (NP)
Entity type:Individual
Prefix:
First Name:TAJA
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 MIDDLESEX DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6449
Mailing Address - Country:US
Mailing Address - Phone:216-269-3503
Mailing Address - Fax:
Practice Address - Street 1:5129 DIXIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1727
Practice Address - Country:US
Practice Address - Phone:502-430-6223
Practice Address - Fax:502-792-7272
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023423363L00000X
KY3014731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner