Provider Demographics
NPI:1316244643
Name:PHILLIPS, ELIZABETH RAZNICK (MSN,FNP-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RAZNICK
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4519
Mailing Address - Country:US
Mailing Address - Phone:931-363-2925
Mailing Address - Fax:931-363-9563
Practice Address - Street 1:1150 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4519
Practice Address - Country:US
Practice Address - Phone:931-363-2925
Practice Address - Fax:931-363-9563
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15658363LF0000X
TNAPN6710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527392Medicaid
TN15658OtherDEPARTMENT OF HEALTH
TN6941150001Medicare NSC
TN1035101459Medicare PIN