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General NPI Number Information
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NPI Number | 1538212147
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Entity Type | Organization
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Legal Business Name | ELIZABETH JAN GILLESPIE CRNA
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 1717 N E ST
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City | PENSACOLA
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State | FL
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Zip | 32501-6339
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Country | US
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Telephone | 850-434-4858
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Fax |
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Provider Business Mailing Address
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Address Line | 3090 COBBLESTONE DR
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City | PACE
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State | FL
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Zip | 32571-8425
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Country | US
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Telephone | 850-995-6193
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | ELIZABETH JAN GILLESPIE
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Credential | CRNA
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Telephone | 850-995-6193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | ARNP 9208292
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License Number State | FL
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