Provider Demographics
NPI:1912005737
Name:FARRIS, ELIZABETH N (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:FARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:N
Other - Last Name:GUARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-924-9985
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:18901 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4827
Practice Address - Country:US
Practice Address - Phone:225-924-9985
Practice Address - Fax:225-924-0884
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1505625Medicaid
LA5C822P848Medicare PIN
56629P786Medicare PIN
LA1505625Medicaid