Provider Demographics
NPI:1801166673
Name:GAMMADA, ELIZABETH DE GUIA (NPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DE GUIA
Last Name:GAMMADA
Suffix:
Gender:F
Credentials:NPC
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Mailing Address - Street 1:1509 OLD COWAN RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1913
Mailing Address - Country:US
Mailing Address - Phone:931-636-2633
Mailing Address - Fax:931-962-1400
Practice Address - Street 1:1509 OLD COWAN RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1913
Practice Address - Country:US
Practice Address - Phone:931-962-2540
Practice Address - Fax:931-962-1400
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN16466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily