Healthcare Provider Details

I. General information

NPI: 1003096652
Provider Name (Legal Business Name): ELIZABETH MARIE WEAVER CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARIE MASCHKE

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29277 US HIGHWAY 19 N
CLEARWATER FL
33761-2102
US

IV. Provider business mailing address

7324 SOUTHWEST FWY STE 1550
HOUSTON TX
77074-2053
US

V. Phone/Fax

Practice location:
  • Phone: 877-872-5788
  • Fax: 866-462-7445
Mailing address:
  • Phone: 713-779-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 9189210
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: