Provider Demographics
NPI:1821731019
Name:MIN, ELIZABETH HARVEY (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HARVEY
Last Name:MIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MICHELLE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1078 HOLLY LEIGH CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6102
Mailing Address - Country:US
Mailing Address - Phone:901-395-9034
Mailing Address - Fax:
Practice Address - Street 1:6029 WALNUT GROVE RD STE 209
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-681-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0012800301Medicaid
TNQ073791Medicaid