Healthcare Provider Details

I. General information

NPI: 1003308347
Provider Name (Legal Business Name): ELIZABETH ANN FRANKLIN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN FLOYD APRN, FNP-C

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 BROADMEADOW RD
RANTOUL IL
61866-2166
US

IV. Provider business mailing address

1114 STAGHORNE WAY
BLOOMINGTON IL
61705-7509
US

V. Phone/Fax

Practice location:
  • Phone: 217-282-3010
  • Fax:
Mailing address:
  • Phone: 217-791-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041354591
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017960
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: