Provider Demographics
NPI:1588762546
Name:SPITZ, ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SPITZ
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 1:1327 ASHLEY RIVER RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5384
Mailing Address - Country:US
Mailing Address - Phone:843-577-4551
Mailing Address - Fax:
Practice Address - Street 1:1327 ASHLEY RIVER RD
Practice Address - Street 2:BUILDING B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5384
Practice Address - Country:US
Practice Address - Phone:843-577-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0605020812255A2300X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer