Provider Demographics
NPI:1518149368
Name:MCAVOY, ELIZABETH COLLEEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:COLLEEN
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:COLLEEN
Other - Last Name:GARUFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1107
Mailing Address - Country:US
Mailing Address - Phone:919-562-9410
Mailing Address - Fax:919-562-2948
Practice Address - Street 1:11200 GOVERNOR MANLY WAY
Practice Address - Street 2:SUITE 309
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8599
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:919-562-2948
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518149368Medicaid
NCNCP746BMedicare PIN