Provider Demographics
NPI:1194904227
Name:ELLIOTT, ANNE MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-9529
Mailing Address - Country:US
Mailing Address - Phone:252-745-2070
Mailing Address - Fax:855-422-9508
Practice Address - Street 1:313 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515-9529
Practice Address - Country:US
Practice Address - Phone:252-745-2070
Practice Address - Fax:855-422-9508
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant