Provider Demographics
NPI:1073951257
Name:REDDIAR, ELIZABETH JOHN (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JOHN
Last Name:REDDIAR
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4421 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2671
Mailing Address - Country:US
Mailing Address - Phone:973-944-4795
Mailing Address - Fax:
Practice Address - Street 1:4421 MERLIN DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2671
Practice Address - Country:US
Practice Address - Phone:973-944-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827862363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health