Provider Demographics
NPI:1457818015
Name:ANDERSEN, ELIZABETH PERSEPHONE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:PERSEPHONE
Last Name:ANDERSEN
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 1:1100 JOHNSON FERRY RD
Mailing Address - Street 2:STE 510
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1743
Mailing Address - Country:US
Mailing Address - Phone:404-419-1165
Mailing Address - Fax:
Practice Address - Street 1:7813 SPIVEY STATION BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAKE SPIVEY
Practice Address - State:GA
Practice Address - Zip Code:30236-2900
Practice Address - Country:US
Practice Address - Phone:770-507-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228808163W00000X
GA2018080794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse