Provider Demographics
NPI:1669524013
Name:TANTON, ELIZABETH A (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:TANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:7825 ATLANTIC AVE
Mailing Address - Street 2:#238
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5022
Mailing Address - Country:US
Mailing Address - Phone:323-562-6692
Mailing Address - Fax:
Practice Address - Street 1:7825 ATLANTIC AVE
Practice Address - Street 2:#238
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5022
Practice Address - Country:US
Practice Address - Phone:323-562-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP2281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner