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General NPI Number Information
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NPI Number | 1013578129
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Entity Type | Individual
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Provider Name | ELIZABETH MICHELLE FITZGERALD FNP-C, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 420 AVENUE F
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City | BOGALUSA
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State | LA
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Zip | 70427
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Country | US
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Telephone | 985-730-6970
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Fax |
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Provider Business Mailing Address
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Address Line | 5959 S SHERWOOD FOREST BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-6038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 205878
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License Number State | LA
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