Provider Demographics
NPI:1194849117
Name:TATE, ELIZABETH DIANE (NP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:TATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2808 FINDLEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5363
Mailing Address - Country:US
Mailing Address - Phone:217-787-3063
Mailing Address - Fax:217-787-3627
Practice Address - Street 1:751 N RUTLEDGE ST
Practice Address - Street 2:SUITE 3501
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4909
Practice Address - Country:US
Practice Address - Phone:217-545-7365
Practice Address - Fax:217-545-1903
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209001709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily