Provider Demographics
NPI:1194340331
Name:AVILES, ELIZABETH (APRN-CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 FAXON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5172
Mailing Address - Country:US
Mailing Address - Phone:972-390-9227
Mailing Address - Fax:
Practice Address - Street 1:2724 FAXON DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5172
Practice Address - Country:US
Practice Address - Phone:469-867-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145452367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife