Provider Demographics
NPI:1093195885
Name:SWIFT, ELIZABETH GRISHAM (APN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRISHAM
Last Name:SWIFT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:GRISHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:848 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4607
Practice Address - Country:US
Practice Address - Phone:901-287-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner