Provider Demographics
NPI:1891216073
Name:VAN, ELIZABETH G (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:VAN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:C
Other - Last Name:GALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9176
Practice Address - Country:US
Practice Address - Phone:843-572-1200
Practice Address - Fax:843-553-0424
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21147363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4702Medicaid