Provider Demographics
NPI:1104064278
Name:FLETCHER, ELIZABETH Y (PA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:Y
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RETREAT VLG
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2421
Mailing Address - Country:US
Mailing Address - Phone:912-434-9316
Mailing Address - Fax:912-357-1401
Practice Address - Street 1:106 RETREAT VLG
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2421
Practice Address - Country:US
Practice Address - Phone:912-434-9316
Practice Address - Fax:912-357-1401
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005492363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical