| Eric Bornemann, RN, CPNP-PC | |
| 
					1318 University Ave, Sewanee, TN 37375-2336  | |
| (931) 598-9761 | |
| Not Available | 
| Full Name | Eric Bornemann | 
|---|---|
| Gender | Male | 
| Speciality | Nurse Practitioner - Pediatrics | 
| Location | 1318 University Ave, Sewanee, Tennessee | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1972930733 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363LP0200X | Nurse Practitioner - Pediatrics | 17935 (Tennessee) | Primary | 
| 363LP0200X | Nurse Practitioner - Pediatrics | RN2281187 (Massachusetts) | Secondary | 
| Entity Name | Amg-southern Tennessee Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1164789467 PECOS PAC ID: 5991765943 Enrollment ID: O20041013001206  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Eric Bornemann, RN, CPNP-PC 99 Walnut St, Apt. 205, Chattanooga, TN 37403-1134 Ph: (617) 279-9202  | Eric Bornemann, RN, CPNP-PC 1318 University Ave, Sewanee, TN 37375-2336 Ph: (931) 598-9761  | 
Mrs. Brooke Shoemaker Moody, CRNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: University Wellness Center 604 University Avenue, Sewanee, TN 37383 Phone: 931-598-1270  | |
Anne Milner Sitz, FNP, BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1314 University Ave, Sewanee, TN 37375 Phone: 931-598-5648 Fax: 931-598-9984  | |
Mindy D Holloway, ACNP-BC, FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 604 University Avenue, Sewanee, TN 37375 Phone: 931-598-1270 Fax: 833-642-0898  |