MEDICARE: ELIZABETH GILLILAND ANDERSON FNP

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	264175	AZ

General Provider Information

NPI Number	:	1376207175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GILLILAND ANDERSON FNP

Provider Business Mailing Address
First Line	:	40 S MAIN ST
Second Line	:	STE 1300
City	:	MEMPHIS
State	:	TN
Zip	:	38103-5513
Country	:	US
Telephone Number	:	901-422-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	21115 E INDEPENDENCE WAY
Second Line	:
City	:	RED ROCK
State	:	AZ
Zip	:	85145-5001
Country	:	US
Telephone Number	:	520-981-0691
Fax Number	:

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

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/28/2021

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