Provider Demographics
NPI:1093715443
Name:GREEN, ELIZABETH JANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:610 STRICKLAND DR
Practice Address - Street 2:SUITE 140
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4786
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6945
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX606373363LF0000X
TXAP113019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205564202Medicaid