Provider Demographics
NPI:1255826350
Name:IDRIS, ELIZABETH DREW (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DREW
Last Name:IDRIS
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 ASHTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5647
Mailing Address - Country:US
Mailing Address - Phone:703-257-8090
Mailing Address - Fax:
Practice Address - Street 1:8100 ASHTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5647
Practice Address - Country:US
Practice Address - Phone:703-257-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily