Provider Demographics
NPI:1457868804
Name:JENNINGS, ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 CLOVERCREST DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2331
Mailing Address - Country:US
Mailing Address - Phone:334-332-5081
Mailing Address - Fax:
Practice Address - Street 1:600 SAINT CLAIR AVE SW BLDG 3
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5057
Practice Address - Country:US
Practice Address - Phone:256-536-4122
Practice Address - Fax:256-382-0801
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-108898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine