Provider Demographics
NPI:1598295503
Name:COMBS, ELIZABETH BERKELEIGH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BERKELEIGH
Last Name:COMBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BERKELEIGH
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:11430 IVYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1538
Mailing Address - Country:US
Mailing Address - Phone:804-937-0910
Mailing Address - Fax:
Practice Address - Street 1:13540 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2107
Practice Address - Country:US
Practice Address - Phone:804-739-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherPTAN