Healthcare Provider Details

I. General information

NPI: 1598744013
Provider Name (Legal Business Name): ELIZABETH SMITH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 EL CAMINO REAL STE 11AB
SIERRA VISTA AZ
85635-2860
US

IV. Provider business mailing address

302 EL CAMINO REAL STE 5
SIERRA VISTA AZ
85635-2860
US

V. Phone/Fax

Practice location:
  • Phone: 520-459-1914
  • Fax: 520-452-2227
Mailing address:
  • Phone: 520-458-4335
  • Fax: 520-452-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR041677
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: