Provider Demographics
NPI:1912305061
Name:SAXTON, ELIZABETH ANN PRUITT (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN PRUITT
Last Name:SAXTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10200 COPPERMINE RD
Practice Address - Street 2:
Practice Address - City:WOODSBORO
Practice Address - State:MD
Practice Address - Zip Code:21798-8319
Practice Address - Country:US
Practice Address - Phone:301-845-6322
Practice Address - Fax:240-578-4480
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0089477163W00000X
MDR218389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCD8143Medicare PIN
MD451LMedicare PIN