Healthcare Provider Details

I. General information

NPI: 1295661999
Provider Name (Legal Business Name): ELIZABETH SUSAN JEFFERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

347 QUAIL PL
CHULA VISTA CA
91911-5519
US

V. Phone/Fax

Practice location:
  • Phone: 198-971-9355
  • Fax:
Mailing address:
  • Phone: 812-605-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number008332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: