Healthcare Provider Details

I. General information

NPI: 1922129519
Provider Name (Legal Business Name): ELIZABETH REA EASON CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E HIBISCUS BLVD
MELBOURNE FL
32901-3155
US

IV. Provider business mailing address

330 E HIBISCUS BLVD
MELBOURNE FL
32901-3155
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-2229
  • Fax: 321-728-6668
Mailing address:
  • Phone: 321-724-2229
  • Fax: 321-728-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1471502
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1471502ARNP
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: