Provider Demographics
NPI:1649688912
Name:SEAL, ELIZABETH ANN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SEAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:6100 OLD BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2543
Mailing Address - Country:US
Mailing Address - Phone:228-867-5057
Mailing Address - Fax:228-867-5048
Practice Address - Street 1:725 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2920
Practice Address - Country:US
Practice Address - Phone:228-466-3099
Practice Address - Fax:228-867-5048
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882671163WG0100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology