Healthcare Provider Details

I. General information

NPI: 1043318546
Provider Name (Legal Business Name): ELIZABETH ANN POLSTON PHD, ARNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN KOSTAS-POLSTON PHD, ARNP, WHNP-BC

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 LAKELAND HILLS BLVD WOMEN'S CARE FLORIDA, LAKELAND OB-GYN
LAKELAND FL
33805-3016
US

IV. Provider business mailing address

2750 GREYHAWK ESTATES LN
LAKELAND FL
33812-5803
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-1528
  • Fax: 863-688-8423
Mailing address:
  • Phone: 417-293-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number143823
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: