MEDICARE: NOVA ELIZABETH GATLIFF APRN

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	163W00000X	Registered Nurse	1076859	KY
2	207VM0101X	Maternal & Fetal Medicine Physician	3004231	KY
3	363L00000X	Nurse Practitioner	3004231	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932404605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOVA ELIZABETH GATLIFF APRN

Provider Business Mailing Address
First Line	:	160 NORTH EAGLE CREEK DRIVE
Second Line	:	SUITE 400
City	:	LEXINGTON
State	:	KY
Zip	:	40509
Country	:	US
Telephone Number	:	859-258-5220
Fax Number	:	859-258-5405

Provider Business Practice Location Address
First Line	:	160 N EAGLE CREEK DR STE 400
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2124
Country	:	US
Telephone Number	:	859-258-5220
Fax Number	:	859-258-5405

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

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	07/21/2022

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