MEDICARE: ELIZABETH JEAN JEFFRIES CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-079425	AL

General Provider Information

NPI Number	:	1205001625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JEAN JEFFRIES CRNP

Provider Business Mailing Address
First Line	:	400 DIAMOND DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-4532
Country	:	US
Telephone Number	:	256-922-7613
Fax Number	:	256-922-7616

Provider Business Practice Location Address
First Line	:	400 DIAMOND DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-4532
Country	:	US
Telephone Number	:	256-922-7613
Fax Number	:	256-922-7616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2008
Last Update Date	:	03/24/2014

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