Provider Demographics
NPI:1942948369
Name:SMITH, ELIZABETH NADRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NADRA
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 SHOAL CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6125
Mailing Address - Country:US
Mailing Address - Phone:404-667-4392
Mailing Address - Fax:
Practice Address - Street 1:1519 SHOAL CREEK DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6125
Practice Address - Country:US
Practice Address - Phone:404-667-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05210353OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS NATIONAL CERTIFICATION BOARD
GARN085855OtherSTATE BOARD OF NURSING