Provider Demographics
NPI:1508222852
Name:WHITAKER, ELIZABETH LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LYNN
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 PINE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7500
Mailing Address - Country:US
Mailing Address - Phone:478-633-0404
Mailing Address - Fax:478-633-0805
Practice Address - Street 1:840 PINE ST STE 990
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7500
Practice Address - Country:US
Practice Address - Phone:478-633-0404
Practice Address - Fax:478-633-0805
Is Sole Proprietor?:No
Enumeration Date:2016-01-01
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily