Provider Demographics
NPI:1053661462
Name:SMITH, ELIZABETH SHARON (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SHARON
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:SHARON
Other - Last Name:SKOGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8333 N 7TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3440
Mailing Address - Country:US
Mailing Address - Phone:602-254-0676
Mailing Address - Fax:602-254-0677
Practice Address - Street 1:8333 N 7TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3440
Practice Address - Country:US
Practice Address - Phone:602-254-0676
Practice Address - Fax:602-254-0677
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF0711046363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner