Healthcare Provider Details

I. General information

NPI: 1023785755
Provider Name (Legal Business Name): ELIZABETH MARIE HAMSTRA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 9TH STREET DR W
PALMETTO FL
34221-4802
US

IV. Provider business mailing address

912 NW 10TH ST
BLUE SPRINGS MO
64015-3058
US

V. Phone/Fax

Practice location:
  • Phone: 941-721-3900
  • Fax:
Mailing address:
  • Phone: 816-240-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN1101343
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021007304
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704422645
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021007304
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: