Provider Demographics
NPI:1336752492
Name:MICK, ELIZABETH B (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:MICK
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:2000 HEALTH PARK DR FL HP2
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:866-346-1426
Practice Address - Street 1:4615 HUNTRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-8510
Practice Address - Country:US
Practice Address - Phone:540-977-0900
Practice Address - Fax:540-977-0550
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-06-02
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Provider Licenses
StateLicense IDTaxonomies
VA0024180057363L00000X
VA0001228709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse