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NPI Code Detail

MEDICARE: ELIZABETH SHANTY FNP-C

MEDICARE: ELIZABETH SHANTY FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner239953AZ

General Provider Information

NPI Number : 1659992436
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH SHANTY FNP-C
Provider Business Mailing Address
First Line : 155 W COMBS RD
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-9108
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1212 S GREENFIELD RD
Second Line :
City : MESA
State : AZ
Zip : 85206-2792
Country : US
Telephone Number : 480-654-8920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2020
Last Update Date : 03/31/2026

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Directions to “ ELIZABETH SHANTY FNP-C” Practice Location

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