Healthcare Provider Details

I. General information

NPI: 1487039061
Provider Name (Legal Business Name): ELIZABETH TJARKS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 5TH AVE NW
WAVERLY IA
50677-1903
US

IV. Provider business mailing address

810 E BREMER AVE
WAVERLY IA
50677-2730
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-4540
  • Fax:
Mailing address:
  • Phone: 319-231-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH120203
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH120203
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberH120203
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: