Provider Demographics
NPI:1376233064
Name:CHOUINARD, ELIZABETH SUSAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8694
Mailing Address - Country:US
Mailing Address - Phone:904-469-4289
Mailing Address - Fax:
Practice Address - Street 1:1699 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8694
Practice Address - Country:US
Practice Address - Phone:904-469-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025948363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health