Provider Demographics
NPI:1164067617
Name:MINTZ, ELIZABETH (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ROSEGATE DR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-4300
Mailing Address - Country:US
Mailing Address - Phone:205-586-4462
Mailing Address - Fax:
Practice Address - Street 1:171 ROSEGATE DR
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-4300
Practice Address - Country:US
Practice Address - Phone:205-586-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2022-02-21
Deactivation Date:2021-12-20
Deactivation Code:
Reactivation Date:2022-02-21
Provider Licenses
StateLicense IDTaxonomies
AL1-159592363LA2100X
AL1-174898163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse