Healthcare Provider Details

I. General information

NPI: 1912295197
Provider Name (Legal Business Name): BRICIN ELIZABETH MARTIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SPRINGHILL RD SUITE 200
BRYANT AR
72019-7568
US

IV. Provider business mailing address

2301 SPRINGHILL RD SUITE 200
BRYANT AR
72019-7568
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-2500
  • Fax: 501-943-3016
Mailing address:
  • Phone: 501-847-2500
  • Fax: 501-943-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA03575
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: