Provider Demographics
NPI:1306228952
Name:MUCHMORE, ELIZABETH OUTLAW (PA-C, MMS, MS, RD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:OUTLAW
Last Name:MUCHMORE
Suffix:
Gender:F
Credentials:PA-C, MMS, MS, RD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:PAIGE
Other - Last Name:OUTLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 HEALTH PARK BLVD
Mailing Address - Street 2:FLAGLER HOSPITAL
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-829-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
FLPA9115135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered