Healthcare Provider Details

I. General information

NPI: 1386387934
Provider Name (Legal Business Name): ELIZABETH BRANNON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 BOILING SPRINGS RD
SPARTANBURG SC
29303-2298
US

IV. Provider business mailing address

1083 BOILING SPRINGS RD
SPARTANBURG SC
29303-2298
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-8647
  • Fax: 864-542-2227
Mailing address:
  • Phone: 864-583-8647
  • Fax: 864-542-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number25871
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: