Healthcare Provider Details

I. General information

NPI: 1598841967
Provider Name (Legal Business Name): ELIZABETH P SEVERANCE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4197 NW 86TH TER FL 3
GAINESVILLE FL
32606-9278
US

IV. Provider business mailing address

PO BOX 100234
GAINESVILLE FL
32610-0234
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5404
  • Fax:
Mailing address:
  • Phone: 352-392-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN2718212
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2718212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: