1538212147 NPI number — ELIZABETH JAN GILLESPIE CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538212147 NPI number — ELIZABETH JAN GILLESPIE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH JAN GILLESPIE CRNA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELIZABETH JAN GILLESPIE
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538212147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3090 COBBLESTONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32571-8425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-995-6193
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 N E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32501-6339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-434-4858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILLESPIE
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
JAN
Authorized Official Title or Position:
CRNA
Authorized Official Telephone Number:
850-995-6193

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  ARNP 9208292 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1300980 03 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430047793 . This is a "RAIL ROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 89932-C . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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