1780654087 NPI number — ELIZABETH C DURGEE ARNP

Table of content: ELIZABETH C DURGEE ARNP (NPI 1780654087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780654087 NPI number — ELIZABETH C DURGEE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURGEE
Provider First Name:
ELIZABETH
Provider Middle Name:
C
Provider Name Prefix Text:
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:
SANTIAGO
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780654087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4881 NW 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32605-4582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-373-6338
Provider Business Mailing Address Fax Number:
352-373-6144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4343 W NEWBERRY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-331-3502
Provider Business Practice Location Address Fax Number:
352-331-3488
Provider Enumeration Date:
01/26/2006

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: 363L00000X , with the licence number:  ARNP 3177022 , 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: 304764400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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