Provider Demographics
NPI:1710476163
Name:HART, ELIZABETH K (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:HART
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 N MCKENZIE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2264
Mailing Address - Country:US
Mailing Address - Phone:251-424-1100
Mailing Address - Fax:251-424-1110
Practice Address - Street 1:1506 N MCKENZIE ST STE 104
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2264
Practice Address - Country:US
Practice Address - Phone:251-424-1100
Practice Address - Fax:251-424-1110
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-161543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner