Healthcare Provider Details

I. General information

NPI: 1699001016
Provider Name (Legal Business Name): ELIZABETH MONAHAN DRISCOLL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR FL 5
CHARLOTTESVILLE VA
22911-4668
US

IV. Provider business mailing address

PO BOX 79777
BALTIMORE MD
21279-0777
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-5260
  • Fax: 844-340-9731
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-823-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175210
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: