Provider Demographics
NPI:1437112141
Name:BARTHOLOMEW, ELIZABETH ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MERIDIAN WAY
Mailing Address - Street 2:#48
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126
Mailing Address - Country:US
Mailing Address - Phone:408-858-6498
Mailing Address - Fax:
Practice Address - Street 1:1993 MCKEE RD
Practice Address - Street 2:MATERNAL FETAL MEDICINE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1406
Practice Address - Country:US
Practice Address - Phone:408-937-2206
Practice Address - Fax:408-937-2205
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568033363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32589ZMedicare ID - Type Unspecified
CAQ35549Medicare UPIN