Healthcare Provider Details

I. General information

NPI: 1508499476
Provider Name (Legal Business Name): ELIZABETH SHIELDS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date: 04/09/2024
Reactivation Date: 05/01/2024

III. Provider practice location address

2150 BROOKMEADE DR STE 130
COLUMBIA TN
38401-4088
US

IV. Provider business mailing address

1909 HAMPSHIRE PIKE
COLUMBIA TN
38401-5650
US

V. Phone/Fax

Practice location:
  • Phone: 931-446-7865
  • Fax:
Mailing address:
  • Phone: 704-451-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36051
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0000229476
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: