Provider Demographics
NPI:1598841967
Name:SEVERANCE, ELIZABETH P (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:P
Last Name:SEVERANCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100234
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0234
Mailing Address - Country:US
Mailing Address - Phone:352-392-3641
Mailing Address - Fax:
Practice Address - Street 1:4197 NW 86TH TER FL 3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9278
Practice Address - Country:US
Practice Address - Phone:352-265-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2718212208000000X
FLARNP2718212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305507800Medicaid