Provider Demographics
NPI:1851846356
Name:DANFORTH, ELISABETH ANNE (APRN, FNP, AGACNP)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:ANNE
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:APRN, FNP, AGACNP
Other - Prefix:MS
Other - First Name:ELISABETH
Other - Middle Name:ANNE
Other - Last Name:DANFORTH MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP, AGACNP
Mailing Address - Street 1:2413 PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2618
Mailing Address - Country:US
Mailing Address - Phone:817-718-4922
Mailing Address - Fax:817-887-1447
Practice Address - Street 1:1575 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4901
Practice Address - Country:US
Practice Address - Phone:817-702-8828
Practice Address - Fax:877-243-5462
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily