Provider Demographics
NPI:1376207175
Name:ANDERSON, ELIZABETH GILLILAND (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GILLILAND
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:STE 1300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5513
Mailing Address - Country:US
Mailing Address - Phone:901-422-7617
Mailing Address - Fax:
Practice Address - Street 1:21115 E INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:RED ROCK
Practice Address - State:AZ
Practice Address - Zip Code:85145-5001
Practice Address - Country:US
Practice Address - Phone:520-981-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ264175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily