Provider Demographics
NPI:1033554092
Name:ISOM, ELIZABETH (MAC, AP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ISOM
Suffix:
Gender:F
Credentials:MAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SE 24TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-0812
Mailing Address - Country:US
Mailing Address - Phone:352-443-1221
Mailing Address - Fax:
Practice Address - Street 1:2801 SE 24TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-0812
Practice Address - Country:US
Practice Address - Phone:352-443-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3230171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist