Healthcare Provider Details

I. General information

NPI: 1508222852
Provider Name (Legal Business Name): ELIZABETH LYNN WHITAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH LYNN PAYNE

II. Dates (important events)

Enumeration Date: 01/01/2016
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 US HIGHWAY 98 W STE 310
MIRAMAR BEACH FL
32550-7232
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-267-2961
  • Fax: 850-278-3780
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN11006316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: