Provider Demographics
NPI:1568559268
Name:TOVAR, ELIZABETH SULLINS (PHD,FNP-C,PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SULLINS
Last Name:TOVAR
Suffix:
Gender:F
Credentials:PHD,FNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 CUSTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4010
Mailing Address - Country:US
Mailing Address - Phone:859-368-0434
Mailing Address - Fax:859-368-0437
Practice Address - Street 1:3150 CUSTER DR STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4010
Practice Address - Country:US
Practice Address - Phone:859-368-0434
Practice Address - Fax:859-368-0437
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666168363LA2100X
KY5215P363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100030120Medicaid
TX170018901Medicaid
TX170018901Medicaid
KY7100030120Medicaid