Provider Demographics
NPI:1356740054
Name:ELIZABETH BREEDLOVE FAMILY PRACTICE & AESTHETICS PLLC
Entity type:Organization
Organization Name:ELIZABETH BREEDLOVE FAMILY PRACTICE & AESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSE PRACITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:903-241-0513
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:TATUM
Mailing Address - State:TX
Mailing Address - Zip Code:75691-1129
Mailing Address - Country:US
Mailing Address - Phone:903-241-0513
Mailing Address - Fax:
Practice Address - Street 1:810 N HILL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TATUM
Practice Address - State:TX
Practice Address - Zip Code:75691-1740
Practice Address - Country:US
Practice Address - Phone:903-241-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty