1083736615 NPI number — MRS. ELIZABETH KATHRYN NEWMAN ARNP

Table of content: MRS. ELIZABETH KATHRYN NEWMAN ARNP (NPI 1083736615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083736615 NPI number — MRS. ELIZABETH KATHRYN NEWMAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
ELIZABETH
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWMAN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1083736615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12424 COUNTY ROAD 49
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVE OAK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32060-7083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-364-8379
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4551 W US HIGHWAY 90 STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32055-8836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-319-8178
Provider Business Practice Location Address Fax Number:
386-243-8786
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  ARNP3090732 , 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)





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