Provider Demographics
NPI:1477144939
Name:BRUSHABER, ELIZABETH FOSTER (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FOSTER
Last Name:BRUSHABER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-5289
Mailing Address - Country:US
Mailing Address - Phone:228-218-5831
Mailing Address - Fax:
Practice Address - Street 1:936 TOMMY MUNRO DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2130
Practice Address - Country:US
Practice Address - Phone:228-396-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily