Healthcare Provider Details

I. General information

NPI: 1114159894
Provider Name (Legal Business Name): ELIZABETH ANN MCDOWELL PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN COOLEY

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR
CRESTVIEW FL
32539-7385
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-1164
  • Fax: 850-682-5302
Mailing address:
  • Phone: 850-385-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9469748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: