Healthcare Provider Details

I. General information

NPI: 1124772298
Provider Name (Legal Business Name): ELIZABETH ANN-HADEN DANNER MSN, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ELIZABETH ANN-HADEN TIDWELL

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WYOMING SPRINGS DR STE 1300
ROUND ROCK TX
78681-4306
US

IV. Provider business mailing address

PO BOX 10597
AUSTIN TX
78766-1597
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-2273
  • Fax: 512-244-3179
Mailing address:
  • Phone: 512-420-0186
  • Fax: 903-200-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1070107
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1070107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: