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General NPI Number Information
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NPI Number | 1861449787
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Entity Type | Individual
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Provider Name | ELIZABETH JAN GILLESPIE CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 3079 PEACHTREE INDUSTRIAL BLVD
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City | DULUTH
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State | GA
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Zip | 30097-2215
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Country | US
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Telephone | 800-945-6133
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Fax | 678-546-3606
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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 | 850-995-6193
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9208292
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License Number State | FL
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