Provider Demographics
NPI:1508499476
Name:SHIELDS, ELIZABETH (APRN-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HAMPSHIRE PIKE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5650
Mailing Address - Country:US
Mailing Address - Phone:704-451-5686
Mailing Address - Fax:
Practice Address - Street 1:2150 BROOKMEADE DR STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4088
Practice Address - Country:US
Practice Address - Phone:931-446-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2024-05-01
Deactivation Date:2024-04-09
Deactivation Code:
Reactivation Date:2024-05-01
Provider Licenses
StateLicense IDTaxonomies
TN0000229476163WC0400X
TN36051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management