Healthcare Provider Details

I. General information

NPI: 1770366320
Provider Name (Legal Business Name): ELIZABETH IRVIN OQUINN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH BROOK IRVIN

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 FABER PLACE DR
NORTH CHARLESTON SC
29405-8533
US

IV. Provider business mailing address

PO BOX 30907
CHARLESTON SC
29417-0907
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-9312
  • Fax: 843-767-9313
Mailing address:
  • Phone: 843-767-9312
  • Fax: 843-767-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27408
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: